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.

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. More importantly, EACA and its ability to help maintain stable blood clots has other applications.

A more effective use of EACA involves prevention of post-surgical bleeding in greyhounds and related breeds. Unfortunately, greyhounds are commonly affected with bone cancer requiring limb amputation. A common scenario would be that the surgery would go well but several days later bleeding would occur at the surgery site. It appears that some greyhounds have a problem with maintaining normal blood clots and these clots are dissolving prematurely. Giving EACA appears to inhibit clot-dissolving enzymes thus allowing the clot to stay in place normally. EACA could be given preventively in anticipation of possible bleeding or after problems have occurred to set things right.

There are many conditions that involve unwanted hemorrhage: surgical procedures where bleeding is high risk, inoperable tumors that tend to bleed spontaneously etc. The applications of a medication that helps to maintain blood clots appear to extend well beyond greyhounds having limb amputations.

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).

SIDE EFFECTS

Approximately 1% of patients report upset stomach with this medication.

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.

Page posted: 7/21/3013
Page last updated: 6/14/2019