The Efficacy and Safety of Epsilon-Aminocaproic Acid for Blood Loss and Transfusions in Spinal Deformity Surgery: A Meta-Analysis.

Abstract

To assess the efficacy and safety of epsilon-aminocaproic acid (EACA) in reducing the blood loss and transfusion volume during open spinal deformity surgery. A systematic search was conducted for all studies written in English published on or before October 2018 in PubMed, EMBASE, and the Cochrane Library that compared antifibrinolytic agents with placebos for open spinal deformity surgeries. The primary outcomes included the total blood loss, intraoperative, and postoperative blood loss, transfusions volume and complication rate. Seven studies that included 525 patients who were diagnosed with spinal deformity. Compared with placebo, the patients who received EACA showed a reduction in the postoperative blood loss (mean difference [MD] -249.80; 95% confidence interval [CI] -375.65 to -123.95; P = 0.0001) and total blood loss (MD -670.30; 95% CI -1142.63 to -197.98; P = 0.005). Furthermore, the patients treated with EACA received approximately 1.67 fewer units of blood (MD -1.67; 95% CI -3.10 to -0.24; P = 0.02). However, in this cohort, no statistically significant differences were observed in the intraoperative blood loss (MD -452.19; 95% CI -1082.21 to 177.83; P = 0.16) and complication rate (odds ratio 0.73; 95% CI 0.16-3.24; P = 0.68). This meta-analysis demonstrated that EACA could be safe and potentially efficacious for reducing blood loss and transfusions volume in patients with spinal deformity surgeries when compared with placebo. In light of the significant heterogeneity, the findings of this meta-analysis should be confirmed in methodologically rigorous and adequately powered clinical trials.