Date of Award

Spring 5-1-2022

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Brian Garrett

First Committee Member

Kacy Ballard

Second Committee Member

Sara Jordan


Tranexamic Acid, Epsilon Aminocaproic Acid, ERAS, Cardiac Surgery, Blood Conservation, Antifibrinolytic

Subject Categories

Medicine and Health Sciences


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



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