The effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion - A preliminary prospective study

Study Design. A prospective study evaluating the efficacy of epsilon -amino caproic acid (EACA) in decreasing perioperative blood loss in idiopathic sc oliosis. Objectives. To compare the perioperative blood loss and need for blood repl acement in two groups of patients undergoing surgery for idiopathic scolios is. One group received intraoperative EACA; the other did not and served as controls. Summary of Background Data. Excessive blood loss increases the operative ti me, risk for blood product disease transmission, postoperative complication s, and costs associated with posterior spinal fusion and instrumentation. E ACA is an antifibrinolytic agent that has been shown to be effective in red ucing perioperative blood loss during pediatric cardiothoracic surgical pro cedures. We hypothesized that it would also be effective in lowering blood loss during posterior spinal fusion for idiopathic scoliosis. Methods. We compared the perioperative blood loss of 28 consecutive pediatr ic patients with idiopathic scoliosis who underwent posterior spinal fusion and received intraoperative EACA with 31 consecutive patients who did not receive this medication and served as a control group. Results. The patients in both groups were similar. Patients in the EACA gro up demonstrated statistically significant decreases in total estimated peri operative blood loss and the need for autologous blood transfusion. The pat ients in the EACA group had no intraoperative or postoperative complication s related to the use of this medication. Conclusions. Based on these preliminary findings, we believe that EACA is h elpful in decreasing blood loss in patients undergoing posterior spinal fus ion and instrumentation, and may decrease the number of autologous units ne eded to maintain safe perioperative hemoglobin levels, thereby improving sa fety and lowering cost associated with scoliosis surgery.