Efficacy of aminocaproic acid in the control of bleeding after total knee and hip arthroplasty

Abstract

Background:To assess the effectiveness and safety of intravenous aminocaproic acid for blood management after total knee and hip arthroplasty.Methods:Electronic databases: PubMed (1950.1–2018.8), EMBASE (1974.1–2018.8), the Cochrane Central Register of Controlled Trials (CENTRAL, 2017.10), Web of Science (1950.1–2018.8), and CNKI (1980.1–2018.8) were systematically searched for clinical controlled trials comparing intravenous aminocaproic acid and placebo after joint arthroplasties. Heterogeneity was assessed using the chi-square test and I-square statistic. The meta-analysis was performed using STATA 12.0 (College Station, TX).Results:Six studies with 756 patients were included. Our meta-analysis revealed that there were significant differences between aminocaproic acid and placebo in terms of total blood loss (SMD = −0.673, 95% CI: −0.825 to −0.520, P <.001), hemoglobin reduction (SMD = −0.689, 95% CI: −0.961 to −0.418, P <.001), drain output (SMD = −2.162, 95% CI: −2.678 to −1.646, P <.001) and transfusion rates (RD = −0.210, 95% CI: −0.280 to −0.141, P <.001).Conclusion:Aminocaproic acid results in a significant reduction of total blood loss, postoperative hemoglobin decline and transfusion requirement in patients undergoing arthroplasties. Due to the limited quality of the evidence currently available, the results of our meta-analysis should be treated with caution.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…EACA is safe and efficient for reducing blood loss and transfusion volumes in spinal deformity surgery and TKA/THA when compared with placebo 484 . Additionally, no increased risk of thromboembolic events was identified 485–487 . Some studies show that TXA is associated with a significant reduction in total blood loss and postoperative Hb drop compared with EACA.…”

“…484 Additionally, no increased risk of thromboembolic events was identified. [485][486][487] Some studies show that TXA is associated with a significant reduction in total blood loss and postoperative Hb drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay and the incidence of postoperative complications.…”

Measurement and Correlation of the Solubility of Aminocaproic Acid in Some Pure and Binary Solvents

“…Aminocaproic acid, also called ε-aminocaproic acid and 6-aminocaproic acid (CAS registry number 60-32-2, Figure ), is a derivative amino acid antifibrinolytic drug. It is a lysine analogue which can be widely used to decrease blood loss in tooth extractions, spinal deformity surgery, total knee and hip arthroplasty surgery, cardiac and thoracic surgery, etc. − Aminocaproic acid can achieve hemostasis by reducing the combination of plasmin and plasminogen with fibrin. The aminocaproic acid is a widely used intermediate for the synthesis of functional crystals and can form biodegradable copolymers with amino acids like α- l -alanine and l -leucine …”