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.
