EPSILON AMINOCAPROC ACID "EACA"

(for veterinary information only)

BRAND NAME: AMICAR

AVAILABLE AS
500 mg and 1000 mg tablets,
oral solution, and injectable

BACKGROUND

EACA is an “antifibrinolytic.” This means that EACA interferes with the body’s natural mechanisms for removing blood clots; in other words, it makes blood clots last longer. This comes into play in two situations: greyhounds and other sighthounds having surgery and in acute trauma cases where there is heavy blood loss. In the greyhound situation, 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 the trauma situation, 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 situation but there are oral forms that can be used in the home setting.

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 in the treatment of spontaneously bleeding tumors (such as hemangiosarcoma) as well. It is also being investigated for treatment of spontaneously 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 with this medication. Long term use has been 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 who have a history of stroke or vascular accident. These patients already have an increased tendency to clot an abnormal or excessive manner and should not have this potential further increased.
  
  
• While injectable EACA is very reasonably priced, oral 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.
  
  
• If a dose is accidentally skipped, do not double up on the next dose. Simply pick up where you left off.
  
  
• EACA may be given with or without food.
  
  
• EACA should be stored at room temperature.

DEGENERATIVE SPINAL DISEASE

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 be disrupting the protective myelin of the spinal cord. 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 very least, this therapy does not cause any harm.

Short version (to help us comply with "Lizzie's Law")

Page posted: 7/21/3013
Page last updated: 10/13/2021