title: Fibrinogen levels following Amicar in surgery for idiopathic scoliosis.
abstract: METHODS
  Prospective evaluation of fibrinogen levels before surgery and after surgery in patients with idiopathic scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI) who received Amicar to decrease perioperative blood loss.
  
  
  OBJECTIVE
  To assess a possible association between postoperative fibrinogen levels and Amicar administration.
  
  
  BACKGROUND
  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. We subsequently measured fibrinogen levels on all postoperative days in 21 consecutive patients with idiopathic scoliosis and found a dramatic increase throughout the postoperative hospitalization. This study is a continuation of our analysis of postoperative fibrinogen levels.
  
  
  METHODS
  We analyzed fibrinogen levels before surgery and on all postoperative days (4 or 5 days) until discharge in 51 consecutive patients, including our 21 previously reported patients, who received Amicar and underwent a PSF and SSI. We also analyzed the same factors with respect to perioperative blood loss as in our previous Amicar studies.
  
  
  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 +/- 308 mL and postoperative suction drainage 532 +/- 186 mL for a total perioperative blood loss of 1297 +/- 311 mL. The perioperative transfusion requirements were 0.5 +/- 0.6 U 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.
authors.affiliation: Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA. ght@po.cwru.edu
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
authors.forename: Ivan
authors.initials: I
authors.lastname: Florentino-Pineda
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
mesh_terms: D000293:Adolescent; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012600:Scoliosis / Q000097:blood* / Q000601:surgery*
chemical_list: D005340:Fibrinogen; D015119:Aminocaproic Acid