Brand Name: Amicar

Available as 500 mg and 1000 mg tablets, oral solution, and injectable 

Background

Epsilon aminocaproic acid (EACA) is an antifibrinolytic. This means that EACA interferes with the body’s natural mechanisms for removing blood clots; it makes blood clots last longer. This interference comes into play in two situations: greyhounds and other sighthounds having surgery and in acute trauma cases with heavy blood loss. With greyhounds, there seems to be an issue where clots are dissolved prematurely, leading to bleeding from an incision site 2-3 days after an otherwise routine surgery. In trauma, after a large amount of bleeding, natural factors that stabilize clots can be depleted, and a little help is needed. This medication is usually given as an injectable in the hospital, but there are oral forms that can be used at home.

How This Medication Is Used

EACA can be used as an oral medication pre- or post-operatively to discourage bleeding or as an intravenous infusion before or after surgery to discourage excessive bleeding. EACA may be used to treat bleeding tumors (such as hemangiosarcoma) as well. It is also being investigated for the treatment of spontaneous bleeding in patients with immune-mediated thrombocytopenia (platelet destruction).

Oral EACA is typically given 2-3 times daily and may be given with or without food. Store the product at room temperature, protected from light. If a compounded (custom-made) formulation is used, follow the instructions provided by the pharmacy. If a dose is accidentally skipped, do not double up on the next dose but simply give the dose when it is remembered and time the next dose accordingly.

Side Effects

Approximately 1% of patients report upset stomach. Long-term use is associated with muscle damage in some cases, so monitoring tests may be recommended.

Interactions With Other Drugs

Patients taking estrogens may have an increased tendency for abnormal clotting, though this rarely is an issue at the low doses used in small animal medicine. Estrogens used in veterinary medicine include DES and estriol.

Concerns and Cautions

• EACA should not be used in patients who have intravascular abnormal blood clotting problems or that have a history of stroke or vascular accident. These patients already have an increased tendency to clot in an abnormal or excessive manner and should not have this potential further increased.
  
  
• While injectable EACA is reasonably priced, EACA tablets are likely to be prohibitively expensive. Oral EACA can be obtained through a compounding pharmacy at a more equitable price. Alternatively, the Chinese herb Yunnan Baiyo, which has a similar action, can be used orally.
  
  
• EACA should be stored at room temperature.

EACA first became of interest in veterinary patients when work at the University of Florida suggested it would be helpful in slowing the progress of degenerative myelopathy in German shepherd dogs. Affected dogs develop neurologic weakness in their rear legs, which progresses inexorably up the spinal cord to the front legs and ultimately to the respiratory muscles, leading to death. The theory was that the neurodegeneration of this disease involves tiny bleeds in the spinal cord and that EACA might mitigate bleeding damage. Alternatively, EACA might inhibit other protein-dissolving enzymes that could disrupt the protective myelin of the spinal cord. The success of this therapy has not panned out, but as there is no other effective therapy for this condition, EACA is still sometimes recommended. Long-term use is required, and side effects are unusual, suggesting that, at the least, this therapy does not cause any harm.