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Epsilon-Aminocaproic Acid in the Treatment of Patients with Acute Promyelocytic Leukemia and Acquired Alpha-2-Plasmin Inhibitor Deficiency

BRADFORD S. SCHWARTZ, M.D.; ELIOT C. WILLIAMS, M.D.; Ph.D.; MAUREEN G. CONLAN, M.D.; and DEANE F. MOSHER, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Bradford S. Schwartz, M.D.; University of Wisconsin, 1300 University Avenue, 2590 Medical Sciences Center; Madison, WI 53706.


Madison, Wisconsin


Ann Intern Med. 1986;105(6):873-877. doi:10.7326/0003-4819-105-6-873
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Patients with acute promyelocytic leukemia often develop bleeding diatheses during treatment. In seven patients who had this disease, the plasma level of alpha-2-plasmin inhibitor was the best predictor of severity of coagulopathy and bleeding. Clinical bleeding occurred when alpha-2-plasmin inhibitor levels measured less than 30% of normal levels. Patients with acute promyelocytic leukemia who had acquired deficiencies of alpha-2plasmin inhibitor were considered to have deficits similar to those in persons congenitally deficient in alpha-2plasmin inhibitor, and were assumed to be at increased risk for bleeding. Treatment with the fibrinolytic inhibitor, epsilon-aminocaproic acid, along with heparin resulted in prompt cessation of bleeding, reversal of laboratory evidence of fibrinolysis, and a decreased need for blood product support. The only thrombotic complication—thrombosis around a central venous catheter—resolved when treatment with epsilon-aminocaproic acid was discontinued. Epsilon-aminocaproic acid is a safe and effective therapy for those patients with acute promyelocytic leukemia who develop coagulopathy associated with low levels of alpha-2-plasmin inhibitor.

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