Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial

Abstract

Aims Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are few prospective studies that directly compare these agents. The purpose of this study was to compare the benefits of intraoperative intravenous TXA with EACA. Patients and Methods A total of 235 patients (90 THA and 145 TKA) were enrolled in this prospective, randomized controlled trial at a single tertiary-care referral centre. In the THA cohort, 53.3% of the patients were female with a median age of 59.8 years (interquartile range (IQR) 53.3 to 68.1). In the TKA cohort, 63.4% of the patients were female with a median age of 65.1 years (IQR 59.4 to 69.5). Patients received either TXA (n = 119) or EACA (n = 116) in two doses intraoperatively. The primary outcome measures included change in haemoglobin level and blood volume, postoperative drainage, and rate of transfusion. Secondary outcome measures included postoperative complications, cost, and length of stay (LOS). Results TKA patients who received EACA had greater drainage (median 320 ml (IQR 185 to 420) vs 158 ml (IQR 110 to 238); p < 0.001), increased loss of blood volume (891 ml (IQR 612 to 1203) vs 661 ml (IQR 514 to 980); p = 0.014), and increased haemoglobin change from the preoperative level (2.1 ml (IQR 1.7 to 2.8) vs 1.9 ml (IQR 1.2 to 2.4); p = 0.016) compared with patients who received TXA. For the THA cohort, no statistically significant differences were observed in any haematological outcome measure. One patient in the EACA group required transfusion. No patient in the TXA group required transfusion. There were no statistically significant differences in number or type of postoperative complications or LOS for either THA or TKA patients regardless of whether they received TXA or EACA. Conclusion For hip and knee arthroplasty procedures, EACA is associated with increased perioperative blood loss compared with TXA. However, there is no significant difference in transfusion rate. While further prospective studies are needed to compare the efficacy of each agent, we currently recommend orthopaedic surgeons to select their antifibrinolytic based on cost and regional availability. Cite this article: Bone Joint J 2019;101-B:1093–1099.

Comparison between epsilon-aminocaproic acid and tranexamic acid for total hip and knee arthroplasty: A meta-analysis

“…These results are consistent with previous studies. 13,14 The pooled results indicated that the Hb levels at discharge in the EACA group were similar to those in the TXA group. The indications for blood transfusion were based on postoperative Hb levels and clinical symptoms of anemia.…”

“…No additional studies were obtained after reviewing the references. Ultimately, three RCTs and three non-RCTs [7][8][9][10]13,14 were eligible for data extraction and the meta-analysis. The search process is shown in Figure 1.…”

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…As the safety of intramuscular and oral regimens has not been supported by a large number of clinical trials, these methods were excluded from this study. Some scholars have suggested that when TXA is used topically in the joint cavity, joint cavity drainage must not be placed after surgery, to avoid loss of drug efficacy 23,24 . Therefore, to reduce the bias in the test results, a temporary clamping scheme for the drainage tube for 4 h after operation was used in this study 11,25 .…”

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…As the safety of intramuscular and oral regimens has not been supported by a large number of clinical trials, these methods were excluded from this study. Some scholars have suggested that when TXA is used topically in the joint cavity, joint cavity drainage must not be placed after surgery, to avoid loss of drug e cacy 23,24 . Therefore, to reduce the bias in the test results, a temporary clamping scheme for the drainage tube for 4 h after operation was used in this study 11,25 .…”