Effect of Epsilon Aminocaproic Acid on Red-Cell Transfusion Requirements in Major Spinal Surgery

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 postoperatively. Primary end-points included total allogeneic RBC transfusions through postoperative day (POD) 8 and postoperative allogeneic plus autologus RBC transfusions through POD 8. Results Mean total allogeneic RBC transfusions were not statistically different between the groups (5.9 units EACA versus 6.9 units placebo; P=0.17). Mean postoperative RBC transfusions in the EACA group was less (2.0 units versus 2.8 units placebo; P=0.03). There was no significant difference in mean estimated intraoperative EBL (2938 cc EACA vs. 3273 cc placebo; P=0.32). Mean intensive care unit length of stay was decreased (EACA 1.8 days versus 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 one-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.

Epsilon Aminocaproic Acid for the Prevention of Delayed Postoperative Bleeding in Retired Racing Greyhounds Undergoing Gonadectomy

“…EACA prevents activation of plasminogen into plasmin on the fibrin surface, by preventing the binding of plasminogen to C‐terminal lysine residues on partially degraded fibrin, thus blocking the plasminogen binding site, which is essential for efficient plasmin formation . EACA neutralizes bleeding states created experimentally in dogs by infusion of plasmin or a plasminogen activator . EACA has a wide therapeutic index; no relevant adverse effects were reported in toxicologic studies in dogs, rabbits, and rats, with doses as high as 0.5 g/kg…”

Retrospective evaluation of the effectiveness of epsilon aminocaproic acid for the prevention of postamputation bleeding in retired racingGreyhounds with appendicular bone tumors: 46 cases (2003–2008)

“…Independently of the use of FFP, administration of EACA was the only parameter that had a significant effect on the frequency of bleeding in the RRGs in this study, in people EACA has been used to manage postoperative bleeding since the 1960s after prostatectomy, after abnormal hemorrhage in women with intrauterine devices, and to treat hematuria and excessive bleeding after dental extractions in hemophiliacs . Since then, EACA has been studied broadly for its efficacy in reducing perioperative blood loss in various types of surgery, including cardiovascular, spinal, acute trauma, and orthopedic surgery . The in vitro and in vivo actions of EACA in dogs were extensively studied in the 1950s and 1960s, but to our knowledge there are not any reports of the use of EACA in dogs since then.…”

“…EACA prevents activation of plasminogen into plasmin on the surface of the fibrin clot, by preventing the binding of plasminogen to C‐terminal lysine residues on partially degraded fibrin, thus blocking reversibly the plasminogen‐binding site (Figure ), which is essential for efficient plasmin formation . EACA can either block enhanced fibrinolytic activity, or rapidly restore hyperfibrinolytic states to normal, thus EACA impedes the dissolution of fibrin clots …”

Comparison of the Intraoperative Outcomes of Intrauterine Instillation of Epsilon-Aminocaproic Acid and Intravenous Oxytocin in Hysteroscopy Surgeries

“…It is being thought that severe military conflicts in Africa shorten the expected lifetime for more than 2 years. In general, WHO had calculated that 269 thousand people had died in 1999 due to the effect of wars and that loss of 8.44 million healthy years of life had occurred (2,3). Wars negatively affect the provision of health services.…”

“…Moreover, the wars cause the migration of qualified health employees, and thus the health services hitches. Assessments made indicate that the effect of destruction in the infrastructure of health continues for 5-10 years even after the finalization of conflicts (3). Due to resource requirements in the restructuring investments after war, the share allocated to health has decreased (1).…”