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

Liu, Wenbin; Li, Gui-Shi; Shen, Peng; Zhang, Fu-Jiang

doi:10.1177/2309499020959158

Cited by 6 publications

(3 citation statements)

References 24 publications

(38 reference statements)

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“…Some studies show that TXA is associated with a significant reduction in total blood loss and postoperative Hb drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay and the incidence of postoperative complications 488–490 …”

Section: Discussionmentioning

confidence: 99%

“…No significant differences are identified in terms of transfusion rates, length of hospital stay and the incidence of postoperative complications. [488][489][490] Tourniquet use in primary total knee arthroplasty Previous meta-analyses had reported that the use of a tourniquet significantly decreased intra-operative blood loss, calculated blood loss and the duration of operation but did not reduce postoperative and total blood loss, the rate of transfusion and the incidence of DVT of the lower extremity or pulmonary embolism. [491][492][493] Recent systematic reviews showed that overall blood loss, operation time and blood transfusion rate did not differ between patients using tourniquet versus not, [494][495][496] but SAEs were significantly more common with the use of the tourniquet, RR 1.73.…”

Section: E-aminocaproic Acid (Eaca) As An Alternative To Tranexamic Acidmentioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

107

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: E-aminocaproic Acid (Eaca) As An Alternative To Tranexamic Acidmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

107

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“…Several more RCTs on this subject have been published without conclusive results. In addition, Liu et al [16] conducted a meta-analysis of RCTs showing that TXA achieves better blood-saving effects comparing with EACA. However, it contained some methodological shortcomings, errors in inclusion criteria and data extraction, and high heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy between tranexamic acid and epsilon-aminocaproic acid for total knee arthroplasty: A meta-analysis of randomized controlled trials

Li,

Guo,

2023

Medicine

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Background: Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) have been demonstrated to reduce blood loss following total knee arthroplasty (TKA). This meta-analysis aimed to compare the efficacy and safety of TXA and EACA in reducing blood loss in primary TKA patients. Methods: A search of the PubMed, Embase, and Cochrane Library databases identified all relevant studies published until December 2022. Randomized controlled trials (RCTs) reporting a comparison of TXA and EACA for TKA patients were selected. The main outcomes were total blood loss (TBL), hemoglobin (Hb) drop on postoperative day 3, intraoperative blood loss, operation time and the transfusion rate were evaluated. The weighted mean differences (WMD) and risk ratio (RR) with 95% confidence intervals (CI) were calculated using a fixed-effects or random-effects model. Stata 12.0 software was used for meta-analysis. Results: Six studies involving 739 (TXA:372; EACA:367) patients were included in this meta-analysis. There was no significant difference in terms of intraoperative blood loss, Hb drop on postoperative day 3, operation time, tourniquet time (TT), transfusion rate and the occurrence of deep venous thrombosis (DVT) between the 2 treatments groups. However, compared with EACA, TXA significant reduced TBL (WMD, 174.60; 95% CI, −244.09 to −105.11). Conclusion: Our research did not demonstrate TXA to be superior to EACA in reducing need for transfusion and Hb drop. TXA was superior than EACA in reducing TBL in TKA patients. More RCTs with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.

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Comment on article by Zhong et al.: Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III–IV calcaneal fractures

Fan¹

2022

International Orthopaedics (SICOT)

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

Cited by 6 publications

References 24 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Comparison of efficacy between tranexamic acid and epsilon-aminocaproic acid for total knee arthroplasty: A meta-analysis of randomized controlled trials

Comment on article by Zhong et al.: Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III–IV calcaneal fractures

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