[HSF] Amicar Dosing

[Mark Levinson]

On Jan 4, 2008, at 2:48 PM, SJROSS at aol.com wrote:

> As part of our blood management program (in the post Aprotinin  
> era), we are
> reviewing our use of epsilon- amino caproic acid (Amicar).
>
> In the literature, there doesn't appear to be good  information   
> regarding
> effectiveness/safety of various dosing regimens. The doses used in   
> some studies
> have differed by nearly ten-fold.
>
> Are any HSF members aware of any evidence that a particular dosing  
> regimen
> is better or safer?
>
> Failing good evidence, could we have a poll of doses used by the  
> members
> programs for adult patients?
>
> What loading dose  (e.g.  10 gm, or 100 mg/kg, etc)?
> When is the loading dose given (e.g. before or after heparin)?
> Any dose in pump?
> Any maintenance dose?  How long is it maintained after CPB?
>
> Could also ask same questions for tranexemic acid
>
> Thanks,
>
> Steve Rossiter
>
>
>

Steve:

I am sorry I missed this posting from earlier in the month.

We use Amicar in the pump.     I will find the dose and post it on  
this list.

We do not use a loading dose.     We just add it to the pump prime.

We do not run a drip after surgery unless the patient bleeds.     If  
the patient
"reheparinizes" after surgery (a rather common event), we give 75 mgs  
of protamine
and then start a Protamine Amikar drip.      In almost every case,  
the bleeding stops
in a few hours.      We have not seen any graft thrombosis with this  
technique.

I will get the doses and post this when I can....

Thanks..

Mark



Mark Levinson, MD.
Founder, Editor-in-Chief
The Heart Surgery Forum®
Multimedia Cardiothoracic Journal
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