Aminocaproic Acid Use in Patients with Hematologic Malignancy: A Case Series

Background: The antifibrinolytic aminocaproic acid is widely used in surgical settings to prevent blood loss and decrease transfusion requirements. Small observational studies have suggested that aminocaproic acid may be useful for prevention or treatment of bleeding due to refractory thrombocytopenia in patients with hematologic disorders.

Objective: We examined the use of aminocaproic acid in patients with hematologic malignancy at our institution including indications for use, dosing, thromboembolic events, and patient outcomes.

Methods: We performed a retrospective review of patients with hematologic malignancies who received aminocaproic acid between January 1, 2008 and December 31, 2012. Inclusion criteria included age 18 or older, diagnosis of hematologic malignancy, admission to an inpatient oncology unit and use of aminocaproic acid for at least 24 hours.

Results: 54 patients met inclusion criteria. Median age was 61.5 years (range 19.9-82.6). Most common patient diagnoses included 20 patients (37%) with acute myeloid leukemia, 8 (14.8%) with non-Hodgkin lymphoma, and 6 (11.1%) with myelodysplastic syndrome. 30 patients (55.6%) underwent stem cell transplant, all within 1 year of index admission. Indications for use of aminocaproic acid included 31 (57.4%) for refractory thrombocytopenia with bleeding, 16 (29.6%) for refractory thrombocytopenia without bleeding, and 7 (13%) for bleeding alone. Sites of bleeding (some patients had >1) included 13 gastrointestinal, 8 epistaxis, 7 oral mucosal, 6 intracranial, 3 hemoptysis, 2 hematuria, 2 retinal hemorrhage, and 1 hemorrhoidal. 23 patients (42.6%) received oral aminocaproic acid, 17 (31.5%) received intravenous, and 14 (25.9%) received both oral and intravenous. Administered doses ranged broadly with a maximum total daily dose of 24g for both intravenous and oral. Median duration of use was 6 days (range 3-14). Median platelet count at time of initiation was 12,000/uL (range 2,000-248,000) and median INR was 1.2 (range 1.0-1.9). Fibrinogen was recorded at initiation in 18 patients (33.3%) with a median of 509 mg/dL (range 102-883). PRA was recorded in 42 patients (77.8%) and was 0% in 18 patients with a median value of 87% in the remaining 24 patients. Three patients (5.7%) developed deep venous thrombosis peri-aminocaproic acid administration, two PICC-related in the upper extremities and one lower extremity in the setting of malignancy-associated lymphadenopathy. 44 patients (81.5%) died by the time of data review, including 11 (20.4%) who died during the index admission. Median time to death from index admission was 125 days (range 6-1321).

Conclusions: 54 patients with a variety of hematologic malignancies received aminocaproic acid during inpatient admission to our institution between 2008 and 2012. Indications for use included both refractory thrombocytopenia without bleeding and bleeding with or without thrombocytopenia. The administered dose of aminocaproic acid ranged broadly, as did the duration of use. Three patients developed deep venous thromboses, none clearly related to aminocaproic acid therapy. Aminocaproic acid may be of clinical utility in this population with a particular risk of bleeding, and further trials are indicated. Guidelines for indications, dosing, and duration of therapy should be developed.