Intraarticular Epsilon Aminocaproic Acid Versus Tranexamic Acid in Total Knee Arthroplasty

Abstract

Objective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis

“…A total of 38 12,24–60 studies, which consisted of 29 RCTs and 9 non‐RCTs, were included in the network analysis. Based on previously described research strategy, we identified 5403 studies.…”

“…Twenty-nine studies 12,24,25,[29][30][31][32][33]36,37,[39][40][41][42][43][44][45]47,[49][50][51][52][53][54][55][56][57][58][59] reported PE/DVT rates. Network diagrams of comparisons on PE/DVT rates are shown in Fig.…”

Como Ficam Pacientes Aguardando Cirurgia De Artroplastia De Joelho Na Pandemia Do Covid19?

“…A última questão a todos foi se o paciente teria disposição para se internar para a cirurgia eletiva naquele momento. Ainda aplicamos o questionário WOMAC 9 para comparação com pacientes desse mesmo hospital que responderam esse mesmo questionário dois anos antes da pandemia (entre julho e dezembro de 2017) 10 .…”

Combination of Intravenous and Intra‐Articular Application of Tranexamic Acid and Epsilon‐Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

“…Antifibrinolytic agents could be administrated intravenously, intra‐articularly, orally or combined. Though several studies have compared the efficacy of TXA and EACA in total joint replacement surgery, none of them compared the two drugs when the drugs were administered in an intravenous and intra‐articular (IV/IA) combined fashion 20–22 . IV/IA combined administration has become more and more common recently in TKA as it can reduce both apparent and hidden blood loss 23,24 .…”

“…Though several studies have compared the efficacy of TXA and EACA in total joint replacement surgery, none of them compared the two drugs when the drugs were administered in an intravenous and intra‐articular (IV/IA) combined fashion. 20 , 21 , 22 IV/IA combined administration has become more and more common recently in TKA as it can reduce both apparent and hidden blood loss. 23 , 24 However, the optimal regimen of antifibrinolytic agents, as well as efficacy of EACA and TXA, are still controversial in TKA.…”