The role of amicar in same-day anterior and posterior spinal fusion for idiopathic scoliosis

George H. Thompson, Ivan Florentino-Pineda, Connie Poe-Kochert, Douglas G. Armstrong, Jochen P. Son-Hing

Research output: Contribution to journalArticle

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Abstract

Study Design.: A retrospective study of the effectiveness of Amicar (epsilon aminocaproic acid). Objective.: Evaluate the effectiveness of Amicar in decreasing perioperative blood loss and transfusion requirements in same-day anterior (ASF) and posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) for idiopathic scoliosis. Summary of background data.: Preliminary prospective, prospective randomized double-blind, and fibrinogen studies have demonstrated Amicar to be effective in decreasing perioperative blood loss in patients with idiopathic scoliosis undergoing PSF with SSI. Increased fibrinogen secretion is a possible explanation. Methods.: There were 73 consecutive patients divided into 3 study groups based on the administration of Amicar: Group 1 (n = 16), no Amicar; Group 2 (n = 18), Amicar for the PSF with SSI only; and Group 3 (n = 39), Amicar for both ASF and PSF with SSI. All patients were managed using the same general anesthesia technique, intraoperative procedure, postoperative care path, and indications for transfusion (hemoglobin <7g/dL). Total perioperative blood loss (estimated intraoperative blood loss for both procedures and measured postoperative chest tube and PSF wound suction drainage) and total transfusion requirements between groups were compared using one-way ANOVA. Results.: There were statistically significant decreases in mean estimated intraoperative PSF with SSI, total perioperative blood loss, and transfusion requirements in the 2 Amicar groups. However, Amicar had no significant effect on estimated intraoperative ASF blood loss, chest tube drainage, or PSF wound suction drainage. Total perioperative blood loss and transfusion requirements (cell saver, autologous, directed, and allogeneic blood) were: 3442.8 ± 1344.0 mL and 1537.1 ± 905.1 mL in Group 1; 2089.8 ± 684.0 mL and 485.2 ± 349.8 mL in Group 2; and 2184.1 ± 1163.7 mL and 531.5 ± 510.5 mL in Group 3. There were no Amicar related complications. Conclusion.: Amicar was highly effective in decreasing total perioperative blood loss and transfusion requirements in same-day ASF and PSF with SSI for idiopathic scoliosis. It results in less preoperative autologous blood donation, perioperative blood transfusion, costs, and potential transfusion-related complications. It was mosteffective in decreasing intraoperative estimated PSF with SSI blood loss. It had no significant effect during the ASF, postoperative chest tube, or PSF wound suction drainage. We now recommend that it be used for the PSF with SSI procedure only.

Original languageEnglish (US)
Pages (from-to)2237-2242
Number of pages6
JournalSpine
Volume33
Issue number20
DOIs
StatePublished - Sep 15 2008

Fingerprint

Aminocaproic Acid
Spinal Fusion
Scoliosis
Blood Transfusion
Chest Tubes
Suction
Postoperative Care
Fibrinogen
Wounds and Injuries
Blood Donors
Double-Blind Method
General Anesthesia
Drainage
Analysis of Variance
Hemoglobins
Retrospective Studies

Keywords

  • Amicar
  • Epsilon aminocaproic acid
  • Estimated anterior spinal fusion blood loss
  • Estimated posterior spinal fusion blood loss
  • Idiopathic scoliosis
  • Postoperative chest tube drainage
  • Postoperative wound suction drainage
  • Total perioperative blood loss

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

The role of amicar in same-day anterior and posterior spinal fusion for idiopathic scoliosis. / Thompson, George H.; Florentino-Pineda, Ivan; Poe-Kochert, Connie; Armstrong, Douglas G.; Son-Hing, Jochen P.

In: Spine, Vol. 33, No. 20, 15.09.2008, p. 2237-2242.

Research output: Contribution to journalArticle

Thompson, George H. ; Florentino-Pineda, Ivan ; Poe-Kochert, Connie ; Armstrong, Douglas G. ; Son-Hing, Jochen P. / The role of amicar in same-day anterior and posterior spinal fusion for idiopathic scoliosis. In: Spine. 2008 ; Vol. 33, No. 20. pp. 2237-2242.
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AU - Thompson, George H.

AU - Florentino-Pineda, Ivan

AU - Poe-Kochert, Connie

AU - Armstrong, Douglas G.

AU - Son-Hing, Jochen P.

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N2 - Study Design.: A retrospective study of the effectiveness of Amicar (epsilon aminocaproic acid). Objective.: Evaluate the effectiveness of Amicar in decreasing perioperative blood loss and transfusion requirements in same-day anterior (ASF) and posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) for idiopathic scoliosis. Summary of background data.: Preliminary prospective, prospective randomized double-blind, and fibrinogen studies have demonstrated Amicar to be effective in decreasing perioperative blood loss in patients with idiopathic scoliosis undergoing PSF with SSI. Increased fibrinogen secretion is a possible explanation. Methods.: There were 73 consecutive patients divided into 3 study groups based on the administration of Amicar: Group 1 (n = 16), no Amicar; Group 2 (n = 18), Amicar for the PSF with SSI only; and Group 3 (n = 39), Amicar for both ASF and PSF with SSI. All patients were managed using the same general anesthesia technique, intraoperative procedure, postoperative care path, and indications for transfusion (hemoglobin <7g/dL). Total perioperative blood loss (estimated intraoperative blood loss for both procedures and measured postoperative chest tube and PSF wound suction drainage) and total transfusion requirements between groups were compared using one-way ANOVA. Results.: There were statistically significant decreases in mean estimated intraoperative PSF with SSI, total perioperative blood loss, and transfusion requirements in the 2 Amicar groups. However, Amicar had no significant effect on estimated intraoperative ASF blood loss, chest tube drainage, or PSF wound suction drainage. Total perioperative blood loss and transfusion requirements (cell saver, autologous, directed, and allogeneic blood) were: 3442.8 ± 1344.0 mL and 1537.1 ± 905.1 mL in Group 1; 2089.8 ± 684.0 mL and 485.2 ± 349.8 mL in Group 2; and 2184.1 ± 1163.7 mL and 531.5 ± 510.5 mL in Group 3. There were no Amicar related complications. Conclusion.: Amicar was highly effective in decreasing total perioperative blood loss and transfusion requirements in same-day ASF and PSF with SSI for idiopathic scoliosis. It results in less preoperative autologous blood donation, perioperative blood transfusion, costs, and potential transfusion-related complications. It was mosteffective in decreasing intraoperative estimated PSF with SSI blood loss. It had no significant effect during the ASF, postoperative chest tube, or PSF wound suction drainage. We now recommend that it be used for the PSF with SSI procedure only.

AB - Study Design.: A retrospective study of the effectiveness of Amicar (epsilon aminocaproic acid). Objective.: Evaluate the effectiveness of Amicar in decreasing perioperative blood loss and transfusion requirements in same-day anterior (ASF) and posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) for idiopathic scoliosis. Summary of background data.: Preliminary prospective, prospective randomized double-blind, and fibrinogen studies have demonstrated Amicar to be effective in decreasing perioperative blood loss in patients with idiopathic scoliosis undergoing PSF with SSI. Increased fibrinogen secretion is a possible explanation. Methods.: There were 73 consecutive patients divided into 3 study groups based on the administration of Amicar: Group 1 (n = 16), no Amicar; Group 2 (n = 18), Amicar for the PSF with SSI only; and Group 3 (n = 39), Amicar for both ASF and PSF with SSI. All patients were managed using the same general anesthesia technique, intraoperative procedure, postoperative care path, and indications for transfusion (hemoglobin <7g/dL). Total perioperative blood loss (estimated intraoperative blood loss for both procedures and measured postoperative chest tube and PSF wound suction drainage) and total transfusion requirements between groups were compared using one-way ANOVA. Results.: There were statistically significant decreases in mean estimated intraoperative PSF with SSI, total perioperative blood loss, and transfusion requirements in the 2 Amicar groups. However, Amicar had no significant effect on estimated intraoperative ASF blood loss, chest tube drainage, or PSF wound suction drainage. Total perioperative blood loss and transfusion requirements (cell saver, autologous, directed, and allogeneic blood) were: 3442.8 ± 1344.0 mL and 1537.1 ± 905.1 mL in Group 1; 2089.8 ± 684.0 mL and 485.2 ± 349.8 mL in Group 2; and 2184.1 ± 1163.7 mL and 531.5 ± 510.5 mL in Group 3. There were no Amicar related complications. Conclusion.: Amicar was highly effective in decreasing total perioperative blood loss and transfusion requirements in same-day ASF and PSF with SSI for idiopathic scoliosis. It results in less preoperative autologous blood donation, perioperative blood transfusion, costs, and potential transfusion-related complications. It was mosteffective in decreasing intraoperative estimated PSF with SSI blood loss. It had no significant effect during the ASF, postoperative chest tube, or PSF wound suction drainage. We now recommend that it be used for the PSF with SSI procedure only.

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KW - Epsilon aminocaproic acid

KW - Estimated anterior spinal fusion blood loss

KW - Estimated posterior spinal fusion blood loss

KW - Idiopathic scoliosis

KW - Postoperative chest tube drainage

KW - Postoperative wound suction drainage

KW - Total perioperative blood loss

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