Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty

Churchill, Jessica L.; Puca, Kathleen E.; Meyer, Elizabeth S.; Carleton, Matthew; Anderson, Michael J.

doi:10.1055/s-0036-1593362

Cited by 28 publications

(37 citation statements)

References 17 publications

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“…Three included studies reported the outcome of the transfusion units per patient [ 7 , 9 , 10 ]. The random model was employed according to a significant heterogeneity ( χ 2 = 26.32, df = 2, I 2 = 92%, P < 0.00001).…”

Section: Resultsmentioning

confidence: 99%

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The efficacy of intravenous aminocaproic acid in primary total hip and knee arthroplasty: a meta-analysis

Bai

et al. 2018

J Orthop Surg Res

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BackgroundWe conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy of aminocaproic acid in cases of primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsPotentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966–2017 October 31), PubMed (1966–2017 October 31), EMBASE (1980–2017 October 31), and ScienceDirect (1985–2017 October 31). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and four non-RCTs met the inclusion criteria. There were significant differences in total blood loss (mean difference (MD) = − 495.80, 95% CI − 837.29 to − 154.32, P = 0.004), drainage volume (MD = − 249.43, 95% CI − 286.78 to − 212.08, P < 0.00001), postoperative hemoglobin level (MD = 0.90, 95% CI 0.78 to 1.02, P < 0.00001), hemoglobin reduction (MD = − 0.75, 95% CI − 0.93 to − 0.57, P < 0.00001), transfusion rates (risk difference (RD) = − 0.17, 95% CI − 0.25 to − 0.09, P < 0.0001), average transfusion units (MD = − 0.28, 95% CI − 0.48 to − 0.09, P = 0.004), and length of hospital stay (MD = − 0.33, 95% CI − 0.43 to − 0.24, P < 0.00001) between the two groups. No significant differences were found regarding deep vein thrombosis (DVT) (RD = − 0.00, 95% CI − 0.01 to 0.00, P = 0.36) between the two groups.ConclusionsThe present meta-analysis indicated that the application of aminocaproic acid in THA or TKA decreases the total blood loss, drainage volume, transfusion rate, transfusion units per patient, and length of hospital stay and does not increase the risk of DVT.

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Section: Resultsmentioning

confidence: 99%

“…The incidence of DVT had been reported in six studies [ 6 , 7 , 9 – 12 ]. The low significant heterogeneity was found, a fixed model was applied ( χ 2 = 1.17, df = 5, I 2 = 0%, P = 0.95).…”

Section: Resultsmentioning

confidence: 99%

The efficacy of intravenous aminocaproic acid in primary total hip and knee arthroplasty: a meta-analysis

Bai

et al. 2018

J Orthop Surg Res

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“…30 Amicar has been noted to have similar efficacy and safety to TXA with the addition of being more cost-effective. 31 However, it has not been as widely studied as TXA, which has a 6-to 10-fold increased affinity for plasminogen. 11 Larger, head-to-head studies are needed to determine if there is a clear indication for the use of one over the other.…”

Section: Tranexamic Acidmentioning

confidence: 99%

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty

2018

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Blood loss management is critical to positive outcomes in patients undergoing total knee arthroplasty (TKA). Transfusions are associated with an increased risk of major and minor adverse events, length of hospitalization, and overall cost associated with surgery. Many techniques have been investigated and compared. Tranexamic acid (TXA), an antifibrinolytic drug widely known to reduce blood loss, may be a bridge to the goal of eliminating blood transfusions from TKA. Administration of TXA can be performed intravenously, topically at the knee joint, orally, or in combination. A single bolus or multiple doses have reduced total blood loss and transfusion rates consistently, safely, and cost-effectively. The uptake in use of TXA by surgeons has been slow due to concerns in patients deemed high risk for thromboembolic events. Newer evidence from studies specifically involving high-risk patients demonstrates that TXA is indeed safe in this cohort and provides benefits that greatly outweigh potential risks. Incorporation of TXA as a routine part of TKA is in the best interest of patients, health care teams, and medical institutions. TXA can be employed seamlessly with other blood saving techniques and has the capacity to increase productivity and decrease overall cost. This can be achieved by reducing the incidence of transfusion and length of stay, and the need for practices such as preoperative anemia treatment and suction drainage.

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“…ε-ACA is an inexpensive medication with a low risk profile (does not carry any risk of anaphylaxis), making it a viable substitute for the generally more expensive antifibrinolytic TXA. 13,16 Studies have already confirmed that topical and intravenous administration can reduce blood loss after knee and hip joint replacement surgery. 17,18 Previous studies have confirmed the use of intravenous TXA by comparing it to aminocaproic acid with similar results regarding total blood loss and transfusion index after TKA.…”

mentioning

confidence: 96%

“…Moreover, the optimal timing and dosage of oral TXA remain unclear, as well as in the case of epsilon-aminocaproic acid (ε-ACA) using empirically high doses in an attempt to replicate the clinical effects of TXA. 13 Each AMICAR (aminocaproic acid) tablet for oral administration contains 1,000 mg of aminocaproic acid and the following inactive ingredients: povidone, crospovidone, stearic acid, and magnesium stearate.…”

mentioning

confidence: 99%

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial

et al. 2019

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Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.

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Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty

Cited by 28 publications

References 17 publications

The efficacy of intravenous aminocaproic acid in primary total hip and knee arthroplasty: a meta-analysis

The efficacy of intravenous aminocaproic acid in primary total hip and knee arthroplasty: a meta-analysis

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial

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