Introduction. Prospective evaluation of fibrinogen levels preoperatively and postoperatively in patients with idiopathic scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI) who received Amicar to decrease perioperative blood loss. Our previous randomized, double-blind (Amicar and control) study demonstrated a rise in fibrinogen levels on the first postoperative day in the Amicar group, but not in the control group. Fibrinogen levels were not measured on the remaining postoperative days.

Methods. We analyzed fibrinogen levels preoperatively and on all postoperative days (4 or 5 days) until discharge in 51 consecutive patients with idiopathic scoliosis, who received Amicar and underwent a PSF and SSI.

Results. There were 41 females and 10 males with a mean age at surgery of 14.2±1.8 years. Their mean hospitalization was 4.6±0.8 days. Their mean estimated intraoperative blood loss was 766±308ml and postoperative suction drainage 532±186ml for a total perioperative blood loss of 1297±311ml. The perioperative transfusion requirements were 0.5±0.6 units per patient. The preoperative fibrinogen was 255.5±58.3 mg/dl, and it rose steadily throughout the postoperative period to 680.9±111.9 mg/dl on the fifth postoperative day. There were no complications related to the use of Amicar.

Conclusions. Fibrinogen levels rise steadily throughout the postoperative period. The significance of this increase is unknown. Was it due to the use of Amicar or just the effects of surgery itself? Further investigations will be necessary.

Introduction: This is a retrospective study of the effectiveness of Amicar in decreasing perioperative blood loss and the need for transfusion in same-day anterior (ASF) and posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) in idiopathic scoliosis. Preliminary prospective, prospective randomized double-blind and fibrinogen studies have demonstrated Amicar to be effective in decreasing perioperative blood loss in idiopathic scoliosis surgery. Increased fibrinogen secretion is a possible explanation.

Methods. Amicar is administered at 100mg/kg over 15 min not to exceed 5 grams at anesthesia induction. Maintenance is 10mg/kg/hr until wound closure. There were three study groups: Group 1, (n=15), no Amicar; Group 2, (n=27), Amicar for the PSF only; and Group 3, (n=16), Amicar for both ASF and PSF.

Results. The total perioperative blood loss (estimated intraoperative blood loss for the ASF and PSF procedures, measured suction drainage and measured chest tube drainage) and the transfusion (autologous and bank blood) requirements were: Group 1, 3807±105ml and 3.1±1.5 units; Group 2 2080±659ml and 1.9±0.9 units; and Group 3 2183±851ml and 1.0±0.8 units.

Conclusions. Amicar appears highly effective in decreasing perioperative blood loss and transfusion requirements in same-day ASF, PSF, with SSI in idiopathic scoliosis. This results in less preoperative autologous blood donation, blood transfusion, costs, and potential transfusion-related complications. It appears to be most effective in decreasing intraoperative PSF blood loss and chest tube drainage. It had no effect during the ASF. We now recommend that it be used for the posterior procedure only.

Introduction and Aims: Evaluate the efficacy of epsilon aminocaproic acid (Amicar) in decreasing peri-operative blood loss in patients with idiopathic scoliosis.

Method: Thirty-six patients participated in this prospective, randomised, double blind, IRB-approved study. The patients who received Amicar were unknown until the completion of the study. All patients were 11–18 years of age, had idiopathic scoliosis, and underwent a posterior spinal fusion and segmental spinal instrumentation using standard hypotensive anesthesia. Factors analysed included age, gender, curve severity, number of vertebrae fused, operating time, hemoglobin and hematocrit pre-operatively and post-operatively, number of autologous units donated, pre-operative and post-operative fibrinogen levels, height, weight, estimated blood volume, estimated intra-operative blood loss, post-operative suction drainage, total peri-operative blood loss, and the autologous transfusion requirements.

Results: Nineteen patients received Amicar and 17 patients were controls. There was no statistical difference between the two groups pre-operatively. Total peri-operative blood loss was statistically less in the Amicar group (p=.036). This was 1,391±212ml in the Amicar group compared to 1,716±513ml in the control group. The decrease was predominantly in the post-operative suction drainage – 605±253ml compared to 939±455ml. The hemoglobin and hematocrits were higher postoperatively in the Amicar group. Interestingly, the fibrinogen levels rose post-operatively in the Amicar group. Total autologous blood transfusions were less in the Amicar group at 1.0±0.8 units compared to 1.7±1.2 units (p=.061). No patient required homologous blood. There were no post-operative complications.

Conclusions: Amicar is a safe, effective, and inexpensive pharmacologic agent that decreases peri-operative blood loss, particularly post-operative suction drainage, in patients with idiopathic scoliosis. This is probably due to increased fibrinogen levels. It results in a significantly decreased need for autologous blood donations pre-operatively and the associated costs.