Skip to main content
Top
Published in: BMC Surgery 1/2010

Open Access 01-12-2010 | Study protocol

A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) for corrective spinal surgery

Authors: Kushagra Verma, Thomas J Errico, Kenneth M Vaz, Baron S Lonner

Published in: BMC Surgery | Issue 1/2010

Login to get access

Abstract

Background

Multilevel spinal fusion surgery has typically been associated with significant blood loss. To limit both the need for transfusions and co-morbidities associated with blood loss, the use of anti-fibrinolytic agents has been proposed. While there is some literature comparing the effectiveness of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) in cardiac procedures, there is currently no literature directly comparing TXA to EACA in orthopedic surgery.

Methods/Design

Here we propose a prospective, randomized, double-blinded control study evaluating the effects of TXA, EACA, and placebo for treatment of adolescent idiopathic scoliosis (AIS), neuromuscular scoliosis (NMS), and adult deformity (AD) via corrective spinal surgery. Efficacy will be determined by intraoperative and postoperative blood loss. Other clinical outcomes that will be compared include transfusion rates, preoperative and postoperative hemodynamic values, and length of hospital stay after the procedure.

Discussion

The primary goal of the study is to determine perioperative blood loss as a measure of the efficacy of TXA, EACA, and placebo. Based on current literature and the mechanism by which the medications act, we hypothesize that TXA will be more effective at reducing blood loss than EACA or placebo and result in improved patient outcomes.

Trial Registration

ClinicalTrials.gov ID: NCT00958581
Literature
1.
go back to reference Guay J, Haig M, Lortie L, Guertin MC, Poitras B: Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth. 1994, 41 (9): 775-81. 10.1007/BF03011583.CrossRefPubMed Guay J, Haig M, Lortie L, Guertin MC, Poitras B: Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth. 1994, 41 (9): 775-81. 10.1007/BF03011583.CrossRefPubMed
3.
go back to reference Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC, Dekutoski MB, Bryant S: Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine. 2000, 25 (5): 596-601. 10.1097/00007632-200003010-00010.CrossRefPubMed Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC, Dekutoski MB, Bryant S: Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine. 2000, 25 (5): 596-601. 10.1097/00007632-200003010-00010.CrossRefPubMed
4.
go back to reference Hur SR, Huizenga BA, Major M: Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine. 1992, 17 (8): 867-73. 10.1097/00007632-199208000-00002.CrossRefPubMed Hur SR, Huizenga BA, Major M: Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine. 1992, 17 (8): 867-73. 10.1097/00007632-199208000-00002.CrossRefPubMed
5.
go back to reference Karkouti K, Dattilo KM: Perioperative hemostasis and thrombosis. Can J Anaesth. 2006, 53 (12): 1260-2. 10.1007/BF03021588.CrossRefPubMed Karkouti K, Dattilo KM: Perioperative hemostasis and thrombosis. Can J Anaesth. 2006, 53 (12): 1260-2. 10.1007/BF03021588.CrossRefPubMed
6.
go back to reference Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O: The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine. 2001, 26 (10): 1152-6. 10.1097/00007632-200105150-00012.CrossRefPubMed Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O: The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine. 2001, 26 (10): 1152-6. 10.1097/00007632-200105150-00012.CrossRefPubMed
7.
go back to reference Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB: Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2008, CD006883-3 Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB: Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2008, CD006883-3
8.
go back to reference Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, Sly K, Laupacis A, Fergusson D: Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007, CD001886-4 Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, Sly K, Laupacis A, Fergusson D: Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007, CD001886-4
9.
go back to reference Mangano DT, Tudor IC, Dietzel C: The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006, 354 (4): 353-65. 10.1056/NEJMoa051379.CrossRefPubMed Mangano DT, Tudor IC, Dietzel C: The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006, 354 (4): 353-65. 10.1056/NEJMoa051379.CrossRefPubMed
10.
go back to reference Thompson GH, Florentino-Pineda I, Poe-Kochert C: The role of amicar in decreasing perioperative blood loss in idiopathic scoliosis. Spine. 2005, 30 (17 Suppl): S94-9. 10.1097/01.brs.0000175188.05542.a9.CrossRefPubMed Thompson GH, Florentino-Pineda I, Poe-Kochert C: The role of amicar in decreasing perioperative blood loss in idiopathic scoliosis. Spine. 2005, 30 (17 Suppl): S94-9. 10.1097/01.brs.0000175188.05542.a9.CrossRefPubMed
11.
go back to reference Florentino-Pineda I, Thompson GH, Poe-Kochert C, Huang RP, Haber LL, Blakemore LC: The effect of amicar on perioperative blood loss in idiopathic scoliosis: the results of a prospective, randomized double-blind study. Spine. 2004, 29 (3): 233-8. 10.1097/01.BRS.0000109883.18015.B9.CrossRefPubMed Florentino-Pineda I, Thompson GH, Poe-Kochert C, Huang RP, Haber LL, Blakemore LC: The effect of amicar on perioperative blood loss in idiopathic scoliosis: the results of a prospective, randomized double-blind study. Spine. 2004, 29 (3): 233-8. 10.1097/01.BRS.0000109883.18015.B9.CrossRefPubMed
13.
go back to reference Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM: A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001, 93 (1): 82-7. 10.1097/00000539-200107000-00018.CrossRefPubMed Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM: A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001, 93 (1): 82-7. 10.1097/00000539-200107000-00018.CrossRefPubMed
14.
go back to reference Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F: Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005, 102 (4): 727-32. 10.1097/00000542-200504000-00006.CrossRefPubMed Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F: Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005, 102 (4): 727-32. 10.1097/00000542-200504000-00006.CrossRefPubMed
15.
go back to reference Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S: Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?. Anesthesiology. 2006, 105 (5): 1034-46. 10.1097/00000542-200611000-00026.CrossRefPubMed Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S: Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?. Anesthesiology. 2006, 105 (5): 1034-46. 10.1097/00000542-200611000-00026.CrossRefPubMed
16.
go back to reference Shapiro F, Zurakowski D, Sethna NF: Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine. 2007, 32 (20): 2278-83. 10.1097/BRS.0b013e31814cf139.CrossRefPubMed Shapiro F, Zurakowski D, Sethna NF: Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine. 2007, 32 (20): 2278-83. 10.1097/BRS.0b013e31814cf139.CrossRefPubMed
17.
go back to reference Chauhan S, Gharde P, Bisoi A, Kale S, Kiran U: A Comparison of aminocaproic Acid and Tranexamic Acid in Adult Cardiac Surgery. Ann Card Anaesth. 2004, 7 (1): 40-3.PubMed Chauhan S, Gharde P, Bisoi A, Kale S, Kiran U: A Comparison of aminocaproic Acid and Tranexamic Acid in Adult Cardiac Surgery. Ann Card Anaesth. 2004, 7 (1): 40-3.PubMed
18.
go back to reference Chauhan S, Das SN, Bisoi A, Kale S, Kiran U: Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2004, 18 (2): 141-3. 10.1053/j.jvca.2004.01.016.CrossRefPubMed Chauhan S, Das SN, Bisoi A, Kale S, Kiran U: Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2004, 18 (2): 141-3. 10.1053/j.jvca.2004.01.016.CrossRefPubMed
19.
go back to reference Pinosky ML, Kennedy DJ, Fishman RL, Reeves ST, Alpert CC, Ecklund J, Kribbs S, Spinale FG, Kratz JM, Crawford R, Gravlee GP, Dorman BH: Tranexamic acid reduces bleeding after cardiopulmonary bypass when compared to epsilon aminocaproic acid and placebo. J Card Surg. 1997, 12 (5): 330-8. 10.1111/j.1540-8191.1997.tb00147.x.CrossRefPubMed Pinosky ML, Kennedy DJ, Fishman RL, Reeves ST, Alpert CC, Ecklund J, Kribbs S, Spinale FG, Kratz JM, Crawford R, Gravlee GP, Dorman BH: Tranexamic acid reduces bleeding after cardiopulmonary bypass when compared to epsilon aminocaproic acid and placebo. J Card Surg. 1997, 12 (5): 330-8. 10.1111/j.1540-8191.1997.tb00147.x.CrossRefPubMed
20.
go back to reference Brecher ME, Monk T, Goodnough LT: A standardized method for calculating blood loss. Transfusion. 1997, 37 (10): 1070-4. 10.1046/j.1537-2995.1997.371098016448.x.CrossRefPubMed Brecher ME, Monk T, Goodnough LT: A standardized method for calculating blood loss. Transfusion. 1997, 37 (10): 1070-4. 10.1046/j.1537-2995.1997.371098016448.x.CrossRefPubMed
21.
go back to reference Verma K, Vecchione D, Dean L, Auerbach J, Lonner B: Reduction of MAP during surgical exposure safely reduces operative blood loss and transfusion requirements. Proceedings of the International Meeting on Advanced Spine Techniques (IMAST). 2009 Verma K, Vecchione D, Dean L, Auerbach J, Lonner B: Reduction of MAP during surgical exposure safely reduces operative blood loss and transfusion requirements. Proceedings of the International Meeting on Advanced Spine Techniques (IMAST). 2009
22.
go back to reference Meunier A, Petersson A, Good L, Berlin G: Validation of a haemoglobin dilution method for estimation of blood loss. Vox Sang. 2008, 95 (2): 120-4. 10.1111/j.1423-0410.2008.01071.x.CrossRefPubMed Meunier A, Petersson A, Good L, Berlin G: Validation of a haemoglobin dilution method for estimation of blood loss. Vox Sang. 2008, 95 (2): 120-4. 10.1111/j.1423-0410.2008.01071.x.CrossRefPubMed
23.
go back to reference Howe C, Paschall C, Panwalkar A, Beal J, Potti A: A model for clinical estimation of perioperative hemorrhage. Clin Appl Thromb Hemost. 2003, 9 (2): 131-5. 10.1177/107602960300900207.CrossRefPubMed Howe C, Paschall C, Panwalkar A, Beal J, Potti A: A model for clinical estimation of perioperative hemorrhage. Clin Appl Thromb Hemost. 2003, 9 (2): 131-5. 10.1177/107602960300900207.CrossRefPubMed
Metadata
Title
A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) for corrective spinal surgery
Authors
Kushagra Verma
Thomas J Errico
Kenneth M Vaz
Baron S Lonner
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2010
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-10-13

Other articles of this Issue 1/2010

BMC Surgery 1/2010 Go to the issue