Related Experiment Video
Updated: Dec 19, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Effect of Intravenous Aminocaproid Acid on Blood Loss and Transfusion Requirements After Bilateral Varus Rotational
Ishaan Swarup1, Joseph Nguyen2, Chris Edmonds3
1Division of Pediatric Orthopaedic Surgery, University of California, San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
Insights
Epsilon-aminocaproic acid (EACA) did not significantly reduce blood loss or transfusion needs in pediatric cerebral palsy patients undergoing femoral osteotomies. This study was underpowered to detect smaller differences, suggesting further research is needed.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Pharmacology
Background:
- Epsilon-aminocaproic acid (EACA) is an antifibrinolytic agent used to reduce blood loss in various surgical settings.
- Its efficacy in pediatric patients with cerebral palsy undergoing bilateral varus rotational femoral osteotomies has not been previously evaluated.
Purpose of the Study:
- To assess the efficacy of intravenous EACA in minimizing intraoperative blood loss and transfusion requirements.
- To evaluate EACA's impact on secondary outcomes like drain output and length of stay in this specific pediatric population.
Main Methods:
- A randomized, placebo-controlled trial was conducted with pediatric patients (≤18 years) undergoing bilateral varus rotational femoral osteotomies.
- Patients received either intravenous EACA or placebo, stratified by sex and additional procedures. The primary outcome was calculated intraoperative blood loss.
Main Results:
- No significant differences were observed in calculated intraoperative blood loss (536 mL vs. 628 mL, P=0.45) or transfusion requirements (62% vs. 67%, P=0.68) between the EACA and placebo groups.
- Secondary outcomes, including 24-hour drain output and length of stay, also showed no significant differences. No complications were reported.
Conclusions:
- Intravenous EACA did not demonstrate a significant reduction in blood loss or transfusion needs compared to placebo in pediatric patients undergoing femoral osteotomies.
- The study was underpowered to detect smaller differences, necessitating larger trials to confirm findings and clarify indications for antifibrinolytics in pediatric surgery.
Background:
ε-Aminocaproic acid (EACA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion requirements in several populations undergoing various surgical procedures. However, the efficacy of EACA has not been assessed in pediatric patients with cerebral palsy undergoing bilateral varus rotational femoral osteotomies. The purpose of this study was to assess the efficacy of intravenous EACA in reducing calculated intraoperative blood loss and transfusions in this population.
Methods:
Patients aged 18 years or younger were eligible. Patients were randomized to receive EACA or placebo (saline), and randomization was stratified based on sex and whether or not additional soft tissue or osseous procedures were performed. On the basis of retrospective data, the calculated sample size was 12 patients per arm to detect a difference of 250-mL blood loss. The primary outcome was calculated intraoperative blood loss. Secondary outcomes included transfusion requirements, 24-hour drain output, length of stay, and incidence of complications.
Results:
The mean age of patients in this study was 8 years (SD: 2.4 y). There were no differences in age, sex, height, weight, type of anesthesia, operative time, and associated procedures between the EACA and placebo groups (P>0.05). Preoperative hematocrit was lower in the EACA group (37.1 vs. 40.0, P=0.04). Calculated intraoperative blood loss was 536 mL in the EACA group and 628 mL in the placebo group (P=0.45). Transfusions were required in 62% of patients in the EACA group and 67% of patients in the placebo group (P=0.68). Total 24-hour drain output was 72.5 mL in the EACA group and 103.3 mL in the placebo group (P=0.37). Length of stay was similar between both groups, and there were no drug or placebo-related complications in either group.
Conclusions:
There was no difference in blood loss or transfusion requirements associated with EACA compared with placebo; however, this study is underpowered to detect smaller differences in blood loss. Additional studies with larger sample sizes are needed to confirm these findings and further elucidate the indications for antifibrinolytic agents in pediatric patients.
Level Of Evidence:
Level I.
