Preventive correction of fibrinolysis with epsilon aminocaproic acid detected by thromboelastometry during liver transplantation

Background: Orthotopic liver transplantation (OLT) is a highly complex procedure, which can be difficult to control intraoperatively in patients with coagulopathies. Aims: The aim of this study was to evaluate the prophylactic administration of epsilon aminocaproic acid (EACA) to reduce the need for transfusion of blood products and its relevance for thrombosis. Methods: Patients were randomized into two groups: one group received EACA (20 mg/kg/h) before surgical incision until the end of OLT and a control group received a similar volume of 0.9% saline solution. Blood was collected to analyze fibrinolysis and coagulation disorders using rotational thromboelastometry (ROTEM®). Results: A total of 24 patients received EACA and 26 patients received saline solution. In the analysis of the fibrinolytic and hemostatic coagulation profile by ROTEM®, fibrinolysis was significantly less frequent in the group of patients treated with EACA (p<0.001) in the anhepatic phase. There were no significant differences in the other extrinsic pathway thromboelastometry and fibrinogen-specific thromboelastometry analyses. In addition, there were no significant differences between both groups regarding the average and percentage transfusion of blood products, postoperative complications, patients who were discharged from the hospital, and those who died within 3 months after liver transplantation. Conclusions: Although the administration of EACA did not reduce the transfusion of blood products, this drug effectively treated fibrinolysis and was not associated with any complications with increased risk of vein and hepatic artery thrombosis or mortality within 3 months after liver transplantation.