The Role of Amicar in Decreasing Perioperative Blood Loss in Idiopathic Scoliosis

Thompson, George H.; Florentino-Pineda, Ivan; Poe-Kochert, Connie

doi:10.1097/01.brs.0000175188.05542.a9

Cited by 51 publications

(31 citation statements)

References 35 publications

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“…Blood conservation techniques have also been extensively studied. Among the strategies that have been investigated include the usage of autologous blood transfusion, [25][26][27] cell salvage, 28 and the usage of various pharmacological agents like esmolol, 29 tranexemic acid, 30,31 amicar, 32,33 aprotinin, 34,35 and epsilon aminocaproic acid 36,37 to reduce blood loss. Two popular strategies that are frequently employed in PSF for AIS are ANH and ICS techniques.…”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Hasan

Choe

Chan

et al. 2017

Journal of Orthopaedic Surgery

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Background: Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery. Methods: Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h). Results: There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 + 1.15 and group B 2.76 + 1.00) showed no significant difference (p ¼ 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 + 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 + 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 + 0.67 g/dl) and within the next 24 h (1.16 + 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion (p ¼ 0.33). Conclusions: The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.

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Section: Discussionmentioning

confidence: 99%

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Hasan

Choe

Chan

et al. 2017

Journal of Orthopaedic Surgery

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“…Antifibrinolytic drugs are widely used, particularly in cardiac and orthopedic surgery, and previous reviews have found them to be effective in reducing blood loss, the need for transfusion, and even the number of reoperations for continued or recurrent bleeding. 47 The use of EACA in our institution has also shown a statistically lower intraoperative estimated blood loss, a total perioperative blood loss (including through the chest tube and Hemovac), and transfusion requirements. However, EACA has a manufacturer-reported risk of causing intracranial hypertension, although this has never been published in neurosurgical, cardiac, orthopedic, or general surgical literature after the intraoperative use of EACA.…”

Section: 45mentioning

confidence: 72%

“…Our experience includes a prospective preliminary study, a randomized double-blinded study, a fibrinogen study, and anterior and posterior spinal fusion studies, as well as a study on neuromuscular disorders. 13,47 However, the serum fibrinogen levels were found to be significantly elevated above normal in the initial 2 weeks after administration of aminocaproic acid. 46,47 Thompson et al 46 had reported that the postoperative fibrinogen levels in the serum of 57 consecutive patients with idiopathic scoliosis increased gradually and substantially from Day 1 to Day 5 after surgery, despite stopping EACA at the end of surgery.…”

Section: 45mentioning

confidence: 99%

“…[46][47][48][49] Our institution has extensive experience with EACA, as more than 1500 spinal deformity cases have been surgically treated since 1998, but there have been no neurological or other complications directly related to its use. Our experience includes a prospective preliminary study, a randomized double-blinded study, a fibrinogen study, and anterior and posterior spinal fusion studies, as well as a study on neuromuscular disorders.…”

Section: 45mentioning

confidence: 99%

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Idiopathic intracranial hypertension following spinal deformity surgery in children

Kunes¹,

Thompson²,

Manjila

et al. 2011

FOC

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Idiopathic intracranial hypertension (IIH) after pediatric spinal deformity surgery has not been previously reported. The authors conducted a retrospective analysis of more than 1500 pediatric spinal surgeries performed between 1992 and 2011. From their analysis, they report on 3 adolescent patients who underwent uncomplicated segmental spinal instrumentation for pediatric spinal deformity correction and subsequently developed features of IIH. The common variables in these 3 patients were adolescent age, spinal deformity, being overweight, symptom onset within 2 weeks postoperatively, significant estimated blood loss, and intraoperative use of ε–aminocaproic acid (antifibrinolytic) injection. The authors postulate that the development of IIH could be the result of venous outflow obstruction due to derangement of the epidural venous plexus during surgery. The use of ε–aminocaproic acid could potentially have the risk of causing IIH, probably mediated through hyperfibrinogenemia, although there have not been published cases in the neurosurgical, orthopedic, cardiac, or general surgical literature. Idiopathic intracranial hypertension after spinal deformity correction is a condition that should be recognized by neurosurgeons and orthopedic surgeons, because appropriate intervention with early medical therapy can lead to a satisfactory clinical outcome.

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“…We have previously reported on the efficacy of Amicar in decreasing perioperative blood loss in idiopathic scoliosis. [17][18][19] We have found no difference in the estimated anterior intraoperative blood loss if Amicar was administered before or after the anterior procedure. 17 We now recommend that Amicar be started before the posterior spinal fusion.…”

Section: Methodsmentioning

confidence: 99%

Video-Assisted Thoracoscopic Surgery in Idiopathic Scoliosis

Son-Hing¹,

Blakemore²,

Poe-Kochert³

et al. 2007

Spine

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The Role of Amicar in Decreasing Perioperative Blood Loss in Idiopathic Scoliosis

Abstract: Amicar appears highly effective in decreasing perioperative blood loss. This results in less autologous blood donation, blood transfusion, costs, and complications. Its mechanism of action is uncertain but may be related to increased fibrinogen secretion.

Cited by 51 publications

References 35 publications

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Idiopathic intracranial hypertension following spinal deformity surgery in children

Video-Assisted Thoracoscopic Surgery in Idiopathic Scoliosis

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