Aminocaproic Acid Administration Guidelines

Introduction to Aminocaproic Acid Administration

The American College of Critical Care recommends administering aminocaproic acid intravenously to achieve therapeutic systemic levels necessary for antifibrinolytic effect 1

Aminocaproic acid requires continuous IV infusion with a loading dose of 150 mg/kg followed by 15 mg/kg/hour to maintain therapeutic drug levels, as its initial elimination half-life is only 60-75 minutes 1
Systemic fibrinolysis occurs throughout the body, not just at surface bleeding sites, requiring systemic antifibrinolytic coverage that cannot be achieved through local bladder instillation 2
Therapeutic plasma levels of a medication are necessary to inhibit fibrinolysis systemically, which can only be achieved through IV administration 2

A loading dose of 150 mg/kg IV should be administered over 1 hour 1
Maintenance infusion of 15 mg/kg/hour should be given as continuous IV infusion until bleeding risk diminishes 1
Alternative dosing protocols may use boluses up to 5g per patient with no adverse effects 1

Continuous bladder irrigation should be maintained separately through the three-way Foley catheter using sterile normal saline or prescribed irrigant 3
Change CBI administration sets every 24 hours if lipid-containing solutions are used, or every 72-96 hours for standard solutions 3
Medications should not be mixed into CBI fluid unless specifically prescribed and validated for intravesical use 3

Aminocaproic acid should be used with extreme caution in massive hematuria due to risk of ureteric obstruction from clot formation 4
Dosage should be reduced in renal failure as aminocaproic acid is renally excreted and accumulates, increasing toxicity risk 1, 4
Aminocaproic acid is contraindicated in active thromboembolic disease or history of thrombosis 4

Aminocaproic acid should be discontinued as soon as bleeding is controlled to minimize thrombotic risk 4
Regular renal function assessment is essential as impaired clearance increases risk of neurotoxicity and ocular toxicity 4
Patients should be assessed for clot obstruction in urinary catheter, particularly with massive hematuria 4