Safety and efficacy of epsilon aminocaproic acid (EACA) as an antihemorrhagic drug in bilateral one stage total knee arthroplasty: A double-blind randomized controlled trial

• Published in: The knee Vol. 27; no. 1; pp. 229 - 234
• Main Authors: Tripathy, Sujit Kumar, Rao, P. Bhaskar, Nanda, Saurav Narayan, Nayak, Chandrakanta, Samal, Barada P., Jain, Mantu, Srinivasan, Anand, Hota, Debasish
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2020; Elsevier Limited
• Subjects: Administration, Intravenous; Aged; Aminocaproic acid; Aminocaproic Acid - therapeutic use; Antifibrinolytic agents; Antifibrinolytic Agents - therapeutic use; Arthroplasty; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - instrumentation; Arthroplasty, Replacement, Knee - methods; Blood; Blood loss; Blood Loss, Surgical - prevention & control; Blood transfusion; Blood transfusions; Body mass index; Clinical trials; Double-Blind Method; Double-blind studies; Drug dosages; Embolisms; Epsilon-aminocaproic acid; Female; Heart attacks; Hemoglobin; Hemostatics - therapeutic use; Humans; Intravenous administration; Joint replacement surgery; Joint surgery; Knee; Male; Middle Aged; Patients; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Postoperative period; Statistical analysis; Studies; Suctioning; Thromboembolism; Thrombosis; Total knee replacement; Tourniquets; Tranexamic acid; Epsilon-aminocaproic acid; Total knee replacement; Blood loss; Tranexamic acid; Arthroplasty; Aminocaproic acid; Blood transfusion
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2019.09.019

Antifibrinolytic drugs are widely used to minimize blood loss and transfusion requirements in total knee arthroplasty (TKA). Although tranexamic acid (TXA) has been widely studied for its use in TKA, there are limited studies on epsilon-aminocaproic acid (EACA). In a double-blind randomized control trial, all patients (n = 91) operated with bilateral simultaneous TKA were randomly given either intravenous EACA or placebo (normal saline). A single surgeon performed the TKA with posterior-stabilized implants under tourniquet. A suction drain was placed and kept for 48 h postoperatively. The intraoperative blood loss and drain output were calculated. The postoperative hemoglobin (Hb), drop in Hb, total blood loss, and number of blood transfusions in each group were calculated. Both of the groups were comparable in terms of age, sex, body mass index, and pre-operative Hb. There was a significant difference between the EACA group and control group in terms of intraoperative blood loss (150 ml vs. 165 ml, P = 0.01), drain output (494 ml vs. 1062 ml, P < 0.001), postoperative Hb (9.9 g/dl vs. 8.6 g/dl, P = 0.002), drop in Hb (2.2 g/dl vs. 3.1 g/dl, P = 0.026) and transfusion rate (median transfusion 0 vs. 1, P < 0.001). The total blood loss, as calculated by the Hb balance method, was significantly less (P < 0.001) in the EACA group (0.99 l) compared with the control group (2.71 l). None of the patients developed any adverse reaction/complication to the drug. Intraoperative administration of EACA significantly decreased the blood loss and postoperative transfusion rates compared with no antifibrinolytic therapy in bilateral simultaneous TKA.