Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery

Sean Berenholtz, Julius Cuong Pham, Elizabeth Garrett-Mayer, Christine W. Atchison, John P. Kostuik, David B Cohen, Shantanu Nundy, Todd Dorman, Paul Michael Ness, Michael John Klag, Peter J. Pronovost, Khaled M Kebaish

Research output: Contribution to journalArticle

Abstract

Study Design: 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. Summary of Background Data: 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). Conclusion: 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 c nsidered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.

Original languageEnglish (US)
Pages (from-to)2096-2103
Number of pages8
JournalSpine
Volume34
Issue number19
DOIs
StatePublished - Sep 2009

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lissamine rhodamine B
Aminocaproic Acid
Placebos
Reconstructive Surgical Procedures
Incidence

Keywords

  • Antifibrinolytic agents
  • Blood transfusions
  • Orthopedic procedures
  • Randomized controlled trial

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery. / Berenholtz, Sean; Pham, Julius Cuong; Garrett-Mayer, Elizabeth; Atchison, Christine W.; Kostuik, John P.; Cohen, David B; Nundy, Shantanu; Dorman, Todd; Ness, Paul Michael; Klag, Michael John; Pronovost, Peter J.; Kebaish, Khaled M.

In: Spine, Vol. 34, No. 19, 09.2009, p. 2096-2103.

Research output: Contribution to journalArticle

Berenholtz, Sean ; Pham, Julius Cuong ; Garrett-Mayer, Elizabeth ; Atchison, Christine W. ; Kostuik, John P. ; Cohen, David B ; Nundy, Shantanu ; Dorman, Todd ; Ness, Paul Michael ; Klag, Michael John ; Pronovost, Peter J. ; Kebaish, Khaled M. / Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery. In: Spine. 2009 ; Vol. 34, No. 19. pp. 2096-2103.
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abstract = "Study Design: 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. Summary of Background Data: 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). Conclusion: 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 c nsidered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.",
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author = "Sean Berenholtz and Pham, {Julius Cuong} and Elizabeth Garrett-Mayer and Atchison, {Christine W.} and Kostuik, {John P.} and Cohen, {David B} and Shantanu Nundy and Todd Dorman and Ness, {Paul Michael} and Klag, {Michael John} and Pronovost, {Peter J.} and Kebaish, {Khaled M}",
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AU - Berenholtz, Sean

AU - Pham, Julius Cuong

AU - Garrett-Mayer, Elizabeth

AU - Atchison, Christine W.

AU - Kostuik, John P.

AU - Cohen, David B

AU - Nundy, Shantanu

AU - Dorman, Todd

AU - Ness, Paul Michael

AU - Klag, Michael John

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AU - Kebaish, Khaled M

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N2 - Study Design: 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. Summary of Background Data: 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). Conclusion: 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 c nsidered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.

AB - Study Design: 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. Summary of Background Data: 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). Conclusion: 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 c nsidered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.

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