Abstract | BACKGROUND: METHODS: This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively and postoperatively. RESULTS: One hundred and twenty-five patients (ninety-seven female and twenty-eight male, with a mean age of fifteen years) were randomized to receive tranexamic acid (thirty-six patients), epsilon-aminocaproic acid (forty-two patients), or saline solution (forty-seven patients). The groups were similar at baseline, with one exception: the saline solution group had a higher estimated blood volume at baseline than the tranexamic acid group. Both tranexamic acid and epsilon-aminocaproic acid reduced the estimated blood loss per degree and estimated blood loss per pedicle screw. Epsilon-aminocaproic acid, but not tranexamic acid, reduced estimated blood loss and estimated blood loss per level. Tranexamic acid also reduced total blood losses compared with epsilon-aminocaproic acid or saline solution. In an analysis controlling for level, degree, and number of anchors, tranexamic acid reduced drain output and total blood losses. Tranexamic acid or epsilon-aminocaproic acid had a smaller decrease in hematocrit postoperatively. In an analysis controlling for the mean arterial pressure during surgical exposure, tranexamic acid reduced estimated blood loss and total blood losses. Overall, antifibrinolytics ( tranexamic acid or epsilon-aminocaproic acid) reduced estimated blood loss, total blood losses, and the decline in hematocrit postoperatively compared with saline solution. There was no difference among the groups with respect to the transfusion rate, duration of surgery, levels fused, or pedicle screws placed. CONCLUSIONS: LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Authors | Kushagra Verma, Thomas Errico, Chris Diefenbach, Christian Hoelscher, Austin Peters, Joseph Dryer, Tessa Huncke, Kirstin Boenigk, Baron S Lonner |
Journal | The Journal of bone and joint surgery. American volume
(J Bone Joint Surg Am)
Vol. 96
Issue 10
Pg. e80
(May 21 2014)
ISSN: 1535-1386 [Electronic] United States |
PMID | 24875032
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Antifibrinolytic Agents
- Tranexamic Acid
- Aminocaproic Acid
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Topics |
- Adolescent
- Aminocaproic Acid
(administration & dosage)
- Antifibrinolytic Agents
(administration & dosage)
- Blood Loss, Surgical
(prevention & control)
- Blood Transfusion
(statistics & numerical data)
- Double-Blind Method
- Female
- Hematocrit
(methods)
- Humans
- Infusions, Intravenous
- Male
- Perioperative Care
(methods)
- Prospective Studies
- Scoliosis
(surgery)
- Spinal Fusion
(methods)
- Tranexamic Acid
(administration & dosage)
- Treatment Outcome
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