Objectives: To compare the effectiveness of epsilon aminocaproic acid (EACA) to tranexamic acid (TA) in reducing blood loss and transfusion requirements in patients undergone cardiac surgery under cardiopulmonary bypass. Design: Randomized, double blinded study. Outcome variables collected included; baseline demographic characteristics, type of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood products administered, 30 day mortality and morbidity and length of stay. We analyzed the data using parametric and non-parametric tests as appropriate. Setting: Single center tertiary-care university hospital setting. Participants: 114 patients who had undergone cardiac surgery under cardiopulmonary bypass. Interventions: Standard dose of intra-operative EACA or TA was compared in patients undergone cardiac surgery under cardiopulmonary bypass. Results: There was no statistically significant difference between groups when analyzing chest tube drainage. However, there was a significant difference in the administration of any transfusion (PRBC's, FFP, platelets) intra-operatively to 24 hours postoperatively, with less transfusion in patients receiving EACA compared to TA (25% vs. 44.8%, respectively P = 0.027). Additionally, there was no significant difference in terms of adverse events during the one month follow up period. Conclusion: The findings of this study suggest that EACA and TA have similar effects on chest tube drainage but EACA is associated with fewer transfusions in CABG alone surgeries. Our results suggest that EACA can be used in a similar fashion to TA which may result in a cost and morbidity advantage.

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The presence of both uterine and arteriovenous malformation in a patient is rare. For these patients a cesarean section can be life threatening due to uncontrolled massive hemorrhage. Prevention and control of massive blood loss utilizing a multidisciplinary approach can be lifesaving. We present a case report of a 33 years old pregnant woman at 35 weeks of gestation diagnosed with an extensive uterine arteriovenous malformation and innumerable tortuous vessels who was scheduled for a cesarean section. Her previous vaginal delivery was complicated by significant bleeding requiring uterine artery embolization. Pre-operative prophylactic aortic and right iliac artery balloon occlusion catheters were placed under monitored anesthesia care. The extracorporeal life support team was available to initiate veno-venous or arteriovenous bypass. Cesarean section was performed with careful identification of the uterine vessels under ultrasound guidance and ultimately the bleeding was well controlled. Postoperatively, the patient underwent uterine artery embolization. It is our strong belief that although we did not face a major disaster during this cesarean section, our comprehensive plan and multi-disciplinary approach were essential to ensuring the safety of the parturient and newborn.