Aminocaproic acid administration is associated with reduced perioperative blood loss and transfusion in pediatric craniofacial surgery

• Published in: Acta anaesthesiologica Scandinavica Vol. 60; no. 2; pp. 158 - 165
• Main Authors: Hsu, G., Taylor, J. A., Fiadjoe, J. E., Vincent, A. M., Pruitt, E. Y., Bartlett, S. P., Stricker, P. A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2016; Wiley Subscription Services, Inc
• Subjects: Aminocaproic Acid - administration & dosage; Antifibrinolytic Agents - administration & dosage; Blood Loss, Surgical - prevention & control; Blood Transfusion; Child, Preschool; Craniotomy; Female; Humans; Infant; Infant, Newborn; Male; Reconstructive Surgical Procedures; Retrospective Studies
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12608

Background Severe blood loss is a common complication of craniofacial reconstruction surgery. The antifibrinolytic ε‐aminocaproic acid (EACA) reduces transfusion requirements in children undergoing cardiac surgery and in older children undergoing spine surgery. Tranexamic acid (TXA), another antifibrinolytic with a similar mechanism of action, has been shown to reduce blood loss and transfusion requirements in children undergoing craniofacial surgery. However, TXA has been associated with an increase in post‐operative seizures and is more expensive than EACA. There is currently little published data evaluating the efficacy of EACA in children undergoing craniofacial surgery. Methods This is a retrospective study of prospectively collected data from our craniofacial perioperative registries for children under 6 years of age who underwent anterior or posterior cranial vault reconstruction. We compared calculated blood loss, blood donor exposures, and post‐operative drain output between subjects who received EACA and those who did not. Results The registry queries returned data from 152 subjects. Eighty‐six did not receive EACA and 66 received EACA. The EACA group had significantly lower calculated blood loss (82 ± 43 vs. 106 ± 63 ml/kg, P = 0.01), fewer intraoperative blood donor exposures (median 2, interquartile range 1–2 vs. median 2, interquartile range 1–3; P = 0.02) and lower surgical drain output in the first post‐operative 24 h (28 ml/kg vs. 37 ml/kg, P = 0.001) than the non‐EACA group. Conclusion In this analysis of prospectively captured observational data, EACA administration was associated with less calculated blood loss, intraoperative blood donor exposures, and post‐operative surgical drain output.