Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery.
METHODS
: Randomized, placebo-controlled trial.


OBJECTIVE
: To evaluate the efficacy of epsilon aminocaproic acid (EACA) to reduce the number of red-cell (RBC) transfusions in adult patients undergoing major spinal surgery.


BACKGROUND
: Reconstructive spinal surgery is associated with significant blood loss. The number of studies evaluating the efficacy of EACA in adult patients undergoing spinal surgery remains scarce and limited.


METHODS
: EACA (100 mg/kg) or placebo was administered to 182 adult patients after the induction of anesthesia followed by an infusion that was continued for 8 hours after surgery. Primary end points included total allogeneic RBC transfusions through postoperative day 8 and postoperative allogeneic plus autologus RBC transfusions through postoperative day 8.


RESULTS
: Mean total allogeneic RBC transfusions were not statistically different between the groups (5.9 units EACA vs. 6.9 units placebo; P = 0.17). Mean postoperative RBC transfusions in the EACA group was less (2.0 units vs. 2.8 units placebo; P = 0.03). There was no significantdifference in mean estimated intraoperative estimated-blood loss (2938 cc EACA vs. 3273 cc placebo; P = 0.32). Mean intensive care unit length of stay was decreased (EACA: 1.8 days vs. 2.8 days placebo; P = 0.04). The incidence of thromboembolic complications was similar (2.2% EACA vs. 6.6% placebo; P = 0.15).


CONCLUSIONS
: The difference in total allogeneic RBC transfusions between the groups was not statistically significant. EACA was associated with a 30% (0.8 units) reduction in postoperative RBC transfusions and a 1-day reduction in ICU LOS, without an increased incidence of thromboembolic events. EACA may be considered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.
Berenholtz
Sean M
SM
Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. sberenh1@jhmi.edu
Pham
Julius Cuong
JC
Garrett-Mayer
Elizabeth
E
Atchison
Christine W
CW
Kostuik
John P
JP
Cohen
David B
DB
Nundy
Shantanu
S
Dorman
Todd
T
Ness
Paul M
PM
Klag
Michael J
MJ
Pronovost
Peter J
PJ
Kebaish
Khaled M
KM
D000328:Adult; D000368:Aged; D015119:Aminocaproic Acid / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D003362:Cost-Benefit Analysis; D003422:Critical Care; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000191:economics; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000191:economics; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics; D013131:Spine / Q000601:surgery*; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid