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

Abstract

Objective: The optimal dose and efficacy of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in total knee arthroplasty (TKA) were under controversial, and we aimed to make comparisons between different doses of TXA and EACA in intravenous (IV) or intra-articular (IA) applications in patients undergoing TKA.Methods: This network meta-analysis was guided by the Priority Reporting Initiative for Systematic Assessment and Meta-Analysis (PRISMA). According to the administrations of antifibrinolytic agents, patients in eligible studies were divided into three subgroups: (i) IA applications of TXA and EACA; (ii) IV applications (g) of TXA and EACA; (iii) IV applications (mg/kg) of TXA and EACA. Total blood loss (TBL), hemoglobin (HB) drops and transfusion rates were the primary outcomes, while drainage volume, pulmonary embolism (PE) or deep vein thrombosis (DVT) risk were the secondary outcomes. A multivariate Bayesian random-effects model was adopted in the network analysis.Results: A total of 38 eligible trials with different regimens were assessed. Overall inconsistency and heterogeneity were acceptable. Taking all primary outcomes into account, 1.0-3.0 g TXA were most effective in IA applications, 1-6 g TXA and 10-14 g EACA were most effective in IV applications (g), while 30 mg/kg TXA and 150 mg/kg EACA were most effective in IV applications (mg/kg). None of the regimens showed increasing risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) compared with placebo.Conclusion: 0 g IA TXA, 1.0 g IV TXA or 10.0 g IV EACA, as well as 30 mg/kg IV TXA or 150 mg/kg IV EACA were most effective and enough to control bleeding for patients after TKA. TXA was at least 5 times more potent than EACA.

Efficacy and safety of tranexamic acid in cervical spine surgery: a systematic review and meta-analysis

“…TXA functions as a competitive antagonist of lysine binding sites on plasminogen, plasmin, and tissue plasminogen. This reversible blockade hinders fibrinolysis and degradation of blood clots and is activated intraoperatively and immediately after surgery, thereby reducing bleeding ( 32 , 33 ). A study of 7,331 trauma patients by Knowlton et al ( 34 ), a study of 168 knee arthroplasty procedures by Xue et al ( 35 ), and a posterior spinal surgery study by Luan et al ( 10 ) showed that use of TXA did not increase the risk of venous thrombosis in the lower extremities.…”

Optimizando la artroplastia total de rodilla: el impacto del ácido tranexámico

“…16 Como resultado, lleva a la estabilización de la red de fibrina preformada por la hemostasia secundaria. 19 Previene la descomposición del fibrinógeno, lo que conlleva a una disminución significativa del sangrado. 17 El ATX se concentra de manera efectiva en el tejido articular; su biodisponibilidad es de aproximadamente 30%, siendo su mecanismo de eliminación principalmente por vía renal.…”

“…La utilización del ATX en la ortopedia se ha enfocado principalmente en el ámbito de la artroplastia total de cadera o rodilla, procedimientos que a menudo conllevan un riesgo significativo de sangrado y complicaciones relacionadas. 19,26,27 Pacientes que experimentan pérdida aguda de sangre debido a sangrado intraoperatorio o postoperatorio importante pueden necesitar recibir transfusiones de productos sanguíneos, lo cual aumenta el riesgo de complicaciones y resulta costoso. 21 Además, las transfusiones de sangre de donantes conllevan riesgos adicionales, como reacciones hemolíticas o anafilácticas, transmisión de infecciones y estancia prolongada en el hospital.…”