Aminocaproic acid stops fibrinolysis by preventing plasminogen from being converted into plasmin. In the following circumstances, it is utilised to ensure hemostasis:
- Urinary fibrinolysis
- Patients with uncontrolled bleeding following surgical procedures especially cardiac surgery
- Neoplastic disorders
- Abruptio placentae,
- Hematologic disorders like patients with hemophilia
- Hepatic cirrhosis, and
It may also be used (off-label) in the following conditions:
- Patients who are on anticoagulants and bleeding due to dental procedures
- Uncontrolled bleeding due to severe thrombocytopenia
- Refractory bleeding associated with extracorporeal membrane oxygenation
- Thrombolytic associated intracranial hemorrhage
Aminocaproic acid Dose in Adults
- Aminocaproic acid dose in acute bleeding:
- During the first hour, provide a loading dosage of 4 to 5 gms orally or intravenously, followed by a maintenance dose of 1 gm/hour for the next 8 hours (or 1.25 g/hour for oral solution), or until bleeding is under control. The highest dose that is suggested per day is 30 gms.
- Aminocaproic acid dose in bleeding patients with severe thrombocytopenia
- Up to 5 gms of 100 mg/kg administered intravenously during a 30- to 60-minute period. The next step is an oral or intravenous infusion of 1 to 4 gms every 4 to 8 hours, or 1 g/hour up to a daily dosage cap of 24 gms.
- Aminocaproic acid dose in patients with uncontrolled bleeding and a congenital or acquired coagulation disorder.
- Every four hours, 50–60 mg/kg.
- Patients with refractory bleeding associated with extracorporeal membrane oxygenation:
- 4 to 5 g intravenous loading dose followed by an infusion rate of 1 to 1.25 g/hour until bleeding is controlled.
- Patients who use thrombolytics in conjunction with iatrogenic intracranial haemorrhage (plasminogen-activator, alteplase, reteplase, tenecteplase)
- As an alternative to cryoprecipitate, provide 4 to 5 g intravenously. After administration, the fibrinogen levels should be assessed. In cases when fibrinogen levels are fewer than 150 mg/dL, cryoprecipitate should be administered.
- In order to stop bleeding during dental procedures in individuals receiving anticoagulant therapy:
- Oral rinse: Spit out the solution after holding 4 g/10 mL of it in your mouth for 2 minutes. After the operation, repeat every six hours for two days.
- For the purpose of preventing post-cardiac surgery perioperative bleeding:
- a loading dose of 75 to 150 mg/kg intravenously, followed by an intravenous infusion of 10 to 15 mg/kg/hour Or
- A loading dosage of 10 grammes followed by 2 grammes every hour throughout surgery, or a loading dose of 10 grammes spread out over 20 to 30 minutes before to the incision, 10 grammes following heparin administration, and finally 10 grammes after cardiopulmonary bypass is stopped.
- Subarachnoid hemorrhage:
- A Loading dose of 4 gms intravenous followed by 1 gm/hour infusion for up to 72 hours after the onset of subarachnoid hemorrhage.
Aminocaproic acid Dose in Childrens
- Control of bleeding in hemophilic patients:
- 50-100 mg/kg/dose four times a day to a maximum of 24 gms per day.
- Control of bleeding in patients with a platelets disorder:
- 50-100 mg/kg/dose four times a day orally or intravenous to a maximum of 24 gms/day.
- Refractory gross hematuria:
- 100 mg/kg/dose four times a day for 2 days beyond the resolution of hematuria in children aged 11 years or more.
- Preventing bleeding in persons with haemophilia (related to dental procedures):
- In conjunction with desmopressin or factor VIII replacement therapy for up to seven days or until recovery is complete, 50-100 mg/kg/dose orally four times a day.
- Extracorporeal membrane oxygenation (ECMO)-associated high-risk patients' bleeding control:
- Prior to cannulation, 100 mg/kg intravenously followed by 25–30 mg/kg/hour for a maximum of 72 hours. During aminocaproic acid treatment, the goal active clotting time (ACT) should fall between 180 and 200 seconds.
Pregnancy Risk Factor C
- Aminocaproic acids have not been used in pregnancy.
Aminocaproic acid use during breastfeeding:
- It is unknown if the drug can be absorbed into breastmilk. It should not be used by nursing women.
Aminocaproic acid Dose in Renal Disease:
- Patients with decreased renal function may have aminocaproic acid accumulation.
- It would make sense to start with a lower loading dosage and then continue at a maintenance continuous infusion rate of 5 mg/kg/hour. 2008, Gravlee
Aminocaproic acid Dose in Liver Disease:
- The manufacturer does not recommend any dose adjustment in liver disease.
Side Effects of Aminocaproic Acid:
- Neuromuscular & skeletal:
- Myalgia
- Myositis
- Rhabdomyolysis
- Cardiovascular:
- Bradycardia
- Edema
- Syncope
- Low blood pressure
- Raised intracranial pressure
- Arrhythmias
- Thrombosis
- Genitourinary:
- Dry ejaculation
- Hematologic:
- Agranulocytosis
- Leukopenia
- Thrombocytopenia.
- Central nervous system:
- Dizziness
- Lethargy
- Hallucinations
- Seizures
- Stroke.
- Confusion
- Delirium
- Headache
- Gastrointestinal:
- Nausea
- Abdominal pain & cramps
- Diarrhea
- Vomiting
- Dermatologic:
- Rash
- Pruritus
- Local:
- Injection site pain & necrosis
- Ophthalmic:
- Watery eyes
- Reduced vision.
- Otic:
- Tinnitus
- Renal:
- Increased BUN
- Acute renal failure.
- Myoglobinuria
- Respiratory:
- Shortness of breath
- Pulmonary embolism.
- Nasal congestion
- Miscellaneous:
- Allergic reactions
- Anaphylaxis
- Rare case reports include myocardial infarction and hyperkalemia
Contraindication to Aminocaproic Acid Include:
- DIAC (Disseminated intravascular Cocoagulation)
- Active intravascular thrombosis
Warnings and Precautions
- Occlusion of the intrarenal:
- There may be clot formation and glossular capillarythrombosis. Aminocaproic acid should not be recommended for patients with hematurias of the upper urinary tract.
- Skeletal muscle weakness
- It has been associated with myalgias and fatigue as well as myopathy in severe cases. If CPK levels rise after therapy is initiated, it should be stopped.
- Do not use factor IX concentrates.
- Patients with severe renal impairment should be cautious.
Aminocaproic acid: Drug Interaction
Note: Drug Interaction Categories:
- Risk Factor C: Monitor When Using Combination
- Risk Factor D: Consider Treatment Modification
- Risk Factor X: Avoid Concomitant Use
Risk Factor C (Monitor therapy). |
|
Tretinoin (Systemic) | Antifibrinolytic agents may have a greater thrombogenic effect. |
Risk Factor X (Avoid Combination) |
|
Complex Anti-inhibitor Coagulant (Human). | Antifibrinolytic agents may increase the thrombogenic effects of Anti-inhibitor Coagulant Complex Human. |
Factor IX Complex (Human). [(Factors II. IX. X)] | Aminocaproic acid may intensify Factor IX Complex Human's toxic/unfavorable impact (Factors II. IX. X). Your chance of getting thrombosis may be up as a result of this combination. |
Monitoring Parameters:
- Creatine phosphokinase with long-term therapy
- BUN, and creatinine.
- Monitor fibrinogen
- Fibrin split products
How to Administer Aminocaproic acid:
- Aminocaproic acid should be given as a slow intravenous infusion over 15 - 60 minutes to avoid hypotension, bradycardia, and arrhythmia.
- The oral formulation may be taken without regard to meals.
Mechansim of Action of Aminocaproic acid:
Aminocaproic acids compete with plasminogen for binding, preventing it from attaching to fibrin. It prevents the breakdown of fibrin, which creates a meshwork close to the site of bleeding, as well as the conversion of plasminogen into plasmin.
- The Onset of action varies from 1 to 72 hours
- It is minimally metabolized by the liver.
- Oral bioavailability is close to 100%
- Half-life elimination is around 2 hours
- The time to peak plasma concentration is around one hour.
- Excretion is mainly via urine.
International Brands of Aminocaproic acid:
- Acepramin
- Acidum e-aminocapronicum
- AKK
- Amicar
- Caproamin
- Caprolest
- Caprolex
- Caprolisin
- EAC
- Epsamon
- Epsicaprom
- Epsikapron
- Epsilon
- Kai Nai Yin
- Minocap
- Hamostat
- Hexalense
- Ipsilon
- Inselon
- Ipron
- Plaslloid
- Resplamin
- Syrop acidi e-aminocapronici
Aminocaproic acid Brands in Pakistan:
No brands available in Pakistan.