Date of Award
Spring 5-1-2022
Document Type
Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Advisor
Brian Garrett
First Committee Member
Kacy Ballard
Second Committee Member
Sara Jordan
Keywords
Tranexamic Acid, Epsilon Aminocaproic Acid, ERAS, Cardiac Surgery, Blood Conservation, Antifibrinolytic
Subject Categories
Medicine and Health Sciences
Abstract
Enhanced Recovery After Surgery (ERAS) guidelines are multimodal perioperative care
pathways based on evidence-based practice to promote faster recovery after surgical procedures.
For cardiac surgery ERAS, one intervention that is strongly recommended based on high levels
of evidence is the use of antifibrinolytic medications, such as Tranexamic acid (TXA) and
epsilon aminocaproic acid (EACA) which are synthetic antifibrinolytics and analogs of lysine,
both known for exerting procoagulant effects by competitively inhibiting activation of
plasminogen to plasmin. Antifibrinolytic medications have been shown to decrease blood loss as
well as the need for blood transfusions and reoperation.
There is strong evidence from the literature for best practices and well-established
international standard ERAS guidelines for cardiac surgery. Reports from key stakeholders in
the pharmacy and anesthesia departments at the project site revealed that the routine use of
antifibrinolytic administration is varied within the cardiac surgical setting. The project team
conducted a chart audit that revealed over a three-month period, only 61% (n= 22/36) of cardiac
surgery patients received an antifibrinolytic. Upon further investigation of the patients that did
not receive an antifibrinolytic, 50% (7/14) of those patients required on pump cardiac surgery
and should have received an antifibrinolytic. A review of the anesthesia records also revealed
variations in dosing among the 22 patients that did receive an antifibrinolytic. 36% (8/22) of
these patients received 10g of EACA, 59% (13/22) received 20g of EACA, and 4% (1/22)
received 10mg of TXA. As a result of the chart audit findings, a clinical practice guideline was
developed for TXA and EACA using the Clinical Guidance Recommendation template at the
institution. The guideline was shared with the Surgery/Anesthesia CPIT Committee for possible
future implementation.
Licensing Permission
Copyright, all rights reserved. Fair Use
Recommended Citation
Foltz, Christopher T. and Lawson, Katonya C., "ERAS for Cardiac Surgery: Development of a Clinical Practice Guideline for Antifibrinolytic Administration in Cardiac Surgery" (2022). Doctor of Nursing Practice Scholarly Projects. 65.
https://digitalcommons.otterbein.edu/stu_doc/65