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

Abstract

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.

Use of Antifibrinolytic Drugs In Primary Total Knee Arthroplasty

“…With the aging of the population, the incidence of joint osteoarthritis is increasing. TKA is one of the most common surgeries used to treat end-stage degenerative knee disease, which is almost always associated with joint pain, deformity, and motor dysfunction [1].…”

“…However, the procedure is associated with substantial blood loss and a high risk of postoperative allogeneic blood transfusion [6]. Transfusion rates after primary and revision total knee arthroplasty range from 4% to 64%, with some reports citing a transfusion rate of up to 93% after bilateral total knee arthroplasty [1,7].…”

“…Average blood loss after total knee replacement has been found to range from 1450 to 1790 mL, leading to anemia and possibly the need for blood transfusion [7]. This significant amount of blood loss leads to swelling, bruising, postoperative stiffness, and possible prolonged drainage, delaying rehabilitation, functional recovery, and discharge from the hospital, increasing health care costs, which often leads to acute anemia and blood transfusion [1]. The leading cause of postoperative blood loss after total knee arthroplasty can be attributed to surgical trauma leading to activation of both the coagulation cascade and local fibrinolysis [7].…”

“…Total Knee Arthroplasty (TKA) is an excellent option for patients with painful arthritis and is recognized as the most cost-effective surgery [1]. During and immediately after major orthopedic surgery, a hyperfibrinolytic phase is observed, leading to increased bleeding.…”

“…The use of Tranexamic Acid (TXA) in primary total knee replacement with cemented implants is supported by studies with a level of evidence confirming its efficacy in reducing blood loss [4] and has become the strategy most popular of the blood preservation of orthopedic surgeons today, reduces transfusions in the TKA by 10-60% depending on the initial transfusion rate [1].…”