Epsilon Aminocaproic Acid's Safety and Efficacy in Pediatric Surgeries Including Craniosynostosis Repair: A Review of the Literature
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Published on: August 24, 2018
Alexander Bolufer1, Takuma Iwai1, Caroline Baughn1
1College of Medicine, University of Central Florida College of Medicine, Orlando, USA.
Insights
Epsilon aminocaproic acid (EACA) effectively reduces blood transfusions in pediatric surgery, including craniosynostosis repair. While not as potent as tranexamic acid (TXA), EACA offers a similar safety profile with a lower seizure risk.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Craniosynostosis surgery necessitates blood transfusions, carrying inherent risks.
- Antifibrinolytics like tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) are used to mitigate blood loss.
- Limited comparative data exists for EACA versus TXA in pediatric craniofacial surgery.
Purpose of the Study:
- To assess the safety and efficacy of EACA in reducing blood loss and transfusion requirements in pediatric patients.
- To explore the potential utility of EACA in pediatric craniofacial (CF) surgery, specifically craniosynostosis repair.
Main Methods:
- A comprehensive literature review of studies from 2000-2021 was conducted.
- Databases searched included PubMed and Cochrane using keywords related to EACA, TXA, and pediatric surgical procedures (scoliosis, cardiothoracic, craniosynostosis).
- Included study types were prospective, retrospective, and meta-analyses.
Main Results:
- EACA consistently reduced blood transfusion volumes compared to control groups.
- EACA demonstrated efficacy comparable to TXA but was not as effective.
- EACA exhibited a comparable safety profile to TXA, with a notably lower risk of seizures.
Conclusions:
- EACA shows promising efficacy and safety for reducing blood loss in pediatric craniosynostosis surgery.
- Further research is warranted to fully establish EACA's role in pediatric craniofacial surgery.
- EACA presents a potentially safer and more cost-effective alternative to TXA in certain pediatric surgical contexts.
Abstract:
Craniosynostosis, the premature fusion of skull sutures in children, requires surgical correction. This procedure routinely requires allogeneic blood transfusions, which are associated with multiple risks of their own. Since 2008, antifibrinolytics tranexamic acid (TXA) and epsilon aminocaproic acid (EACA or Amicar) have been widely used. There is literature comparing the two agents in scoliosis and cardiothoracic surgery, but the literature comparing the two agents in pediatric craniofacial surgery (CF) is limited. Tranexamic acid use is more common in pediatric CF surgery and has been thoroughly studied; however, it costs about three times as much as EACA and has been associated with seizures. This study compiles the literature assessing the safety and efficacy of EACA in reducing blood loss and transfusion volumes in children and explores its potential use in pediatric CF surgery. Papers from 2000 to 2021 regarding the effectiveness and safety of EACA in Pediatric scoliosis, cardiothoracic, and craniosynostosis surgery were reviewed and compiled. Papers were found via searching PubMed and Cochrane databases with the key terms: Epsilon aminocaproic acid, EACA, Amicar, Tranexamic acid, TXA, craniosynostosis, scoliosis, cardiothoracic, and pediatric. Prospective studies, retrospective studies, and meta-analyses were included. Twenty-nine papers were identified as pertinent from the literature searched. Four were meta-analyses, 14 were retrospective, and 11 were prospective. Of these papers, seven were of cardiac surgery, 12 were of scoliosis, and nine were of craniosynostosis. During our search, EACA has been shown to consistently reduce blood transfusion volumes compared to control. However, it is not as effective when compared to TXA. EACA has a similar safety profile to TXA but has a reduced risk of seizures. There are not many studies of EACA in craniosynostosis repair, but the existing literature shows promising results for EACA's efficacy and safety, warranting more studies.
