The Effect of Amicar on Perioperative Blood Loss in Idiopathic Scoliosis: Report of a Prospective, Randomized, Double Blind Study

Purpose: Confirm the efficacy of epsilon aminocaproic acid (Amicar) in decreasing perioperative blood loss in idiopathic scoliosis.

Methods: Thirty-six patients participated in this prospective, randomized, double blind, IRB approved study. The patients were randomized, and those who received Amicar were unknown until the completion of the study. All patients were 11–18 years of age, had idiopathic scoliosis, and underwent a PSF and SSI using standard hypotensive anesthesia. Numerous factors were analyzed, including age, gender, measurement of the major curve, number of vertebrae fused, operating room time, length of hospital stay, hemoglobin and hematocrit analysis preoperatively and on the 1st, 2nd, and 3rd day postoperatively, the number of autologous units donated, the preoperative and postoperative fibrinogen level, height, weight, estimated blood volume, estimated intraoperative blood loss, postoperative suction drainage, total perioperative blood loss, and the autologous and homologous blood transfusion requirements.

Results: Nineteen patients received Amicar and 17 patients were controls. There was no statistical difference between the two groups preoperatively. Total perioperative blood loss was statistically less in the Amicar group (p<0.05). This was 1,391 ml (range, 804-1,895 ml) as compared to 1,716 ml (range, 960-3,105ml) in the control group. The hemoglobin and hematocrits were higher postoperatively in the Amicar group. Interestingly, the fibrinogen levels rose postoperatively in the Amicar group. Total autologous blood transfusions were less in the Amicar group at 1.0 units compared to 1.6 units. No patient required homologous blood. There were no postoperative complications.

Conclusions: Amicar is a safe, effective, and inexpensive pharamcologic agent that decreases perioperative blood loss in patients with idiopathic scoliosis. It results in significantly decreased need for autologous blood donations preoperatively and the associated costs.