Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid

Sucher, Mark; Giordani, Mauro; Figoni, Andrew; Nedopil, Alexander J.

doi:10.1007/s00264-015-3103-1

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…It consists of two steps: degradation of fibrin and activation of plasminogen [23]. Antifibrinolytic agents such as TXA and EACA decrease blood loss by attenuating this fibrinolytic process [6–8].…”

Section: Discussionmentioning

confidence: 99%

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

et al. 2019

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Introduction Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [ 1 ]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery. Materials and methods MEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics. Results Three studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) −0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI −0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI −0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI −0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI −0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61). Conclusions This study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA s...

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Section: Discussionmentioning

confidence: 99%

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

et al. 2019

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“…Five articles [18–22] showed the total blood loss after TJA. A random-effect model was adopted (χ 2 = 0.78, df = 4, I 2 = 0%, P = .941).…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…Three articles [19,21,22] reported postoperative drain output. There was significant difference in terms of postoperative drain output between groups (SMD = −2.162, 95% CI: −2.678 to −1.646, P <.001; Fig.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

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

Wang

2019

Medicine

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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.

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“…[ 10 , 11 ] Guerreiro et al [ 12 ] reported intravenous tranexamic acid reduced intraoperative and postoperative blood loss and thus reduced the need of allogenic blood transfusion in total knee arthroplasty. Sucher et al [ 13 ] indicated that intraoperative use of aminocaproic acid did not appear to increase the risk of postoperative complication in total hip arthroplasty. Compared with total joint arthroplasties, PAO was associated with more blood loss and higher transfusion rates.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of anti-fibrinolytic agents in blood management following peri-acetabular osteotomy

Wang

Tan

Wu³

et al. 2018

Medicine

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Background:Blood management after peri-acetabular osteotomy (PAO) has become a serious problem. We performed a meta-analysis to evaluate the efficacy and safety of antifibrinolytics for blood management after PAO.Methods:PubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to January, 2018 without restrictions on publication date and language. We also searched the relevant publication sources. The research was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Randomized controlled trials (RCTs) and non-RCTs were included in our study. Weighted mean differences, risk difference, and 95% confidence intervals were calculated. We assessed statistical heterogeneity for each outcome with the use of a standard chi-square test and I2 statistic. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Primary outcomes were total blood loss, postoperative hemoglobin decline, and transfusion rates. Secondary outcomes were length of a hospital stay and postoperative complications.Results:Four studies including 1 RCT and 3 non-RCTs were included in our study. The present meta-analysis indicated that antifibrinolytics was associated with a significant reduction of the total blood loss, postoperative hemoglobin decline, transfusion rates, and length of a hospital stay compared with control groups. No significant differences were identified in terms of the incidence of postoperative complications.Conclusion:Intravenous antifibrinolytics was efficacious in reduction of total blood loss, postoperative hemoglobin decline, and length of a hospital stay after PAO without increasing the risk of thromboembolic complications. More high-quality RCTs with long follow-up period were necessary for proper comparisons of the efficacy and safety of antifibrinolytics with placebo.

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Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid

Cited by 16 publications

References 26 publications

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

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

The efficacy and safety of anti-fibrinolytic agents in blood management following peri-acetabular osteotomy

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