Bolufer Alexander, Iwai Takuma, Baughn Caroline, Clark Alec C, Olavarria Greg
College of Medicine, University of Central Florida College of Medicine, Orlando, USA.
Pediatric Surgery, University of Central Florida College of Medicine, Orlando, USA.
Cureus. 2022 May 21;14(5):e25185. doi: 10.7759/cureus.25185. eCollection 2022 May.
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.
小儿颅骨缝早闭是指儿童颅骨缝线过早融合，需要进行手术矫正。该手术通常需要输注异体血，而异体血输注本身存在多种风险。自2008年以来，抗纤溶药物氨甲环酸（TXA）和氨基己酸（EACA或止血芳酸）已被广泛使用。有文献比较了这两种药物在脊柱侧弯和心胸外科手术中的应用，但比较这两种药物在小儿颅面外科手术（CF）中的文献有限。氨甲环酸在小儿CF手术中的使用更为常见，并且已经得到了充分研究；然而，它的成本约为EACA的三倍，并且与癫痫发作有关。本研究汇编了评估EACA在减少儿童失血和输血量方面的安全性和有效性的文献，并探讨了其在小儿CF手术中的潜在用途。回顾并汇编了2000年至2021年关于EACA在小儿脊柱侧弯、心胸和颅骨缝早闭手术中的有效性和安全性的论文。通过在PubMed和Cochrane数据库中搜索关键词：氨基己酸、EACA、止血芳酸、氨甲环酸、TXA、颅骨缝早闭、脊柱侧弯、心胸和小儿，找到了相关论文。纳入了前瞻性研究、回顾性研究和荟萃分析。从搜索到的文献中确定了29篇相关论文。其中4篇是荟萃分析，14篇是回顾性研究，11篇是前瞻性研究。在这些论文中，7篇是关于心脏手术的，12篇是关于脊柱侧弯的，9篇是关于颅骨缝早闭的。在我们的搜索过程中，与对照组相比，EACA已被证明能持续减少输血量。然而，与TXA相比，它的效果并不那么好。EACA的安全性与TXA相似，但癫痫发作风险较低。关于EACA在颅骨缝早闭修复中的研究并不多，但现有文献显示EACA的疗效和安全性有令人鼓舞的结果，值得进行更多研究。
