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Orthopedic surgeons may choose between TXA and epsilon-aminocaproic acid for TKA based on cost, availability
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LAS VEGAS — Compared with tranexamic acid for patients who underwent total knee arthroplasty, epsilon-aminocaproic acid was linked with increased perioperative blood loss. However, there was no significant difference between the medications regarding the transfusion rate, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Looking at the difference in the change in hemoglobin, 1.9 vs. 2.1, we felt it wasn’t clinically significant and certainly did not contribute to the need for a transfusion,” Kendall E. Bradley, MD, said during her presentation. “Orthopedic surgeons should be able to select their antifibrinolytic acid based on cost and regional availability, as in our institution we sometimes have some shortages and the cost for epsilon-aminocaproic acid is about six-times less than what it is for tranexamic acid.”
At a single tertiary referral center, Bradley and colleagues performed a prospective, randomized controlled trial of 145 patients who underwent TKA. Of this group, 73 patients received intravenous tranexamic acid (TXA) and 72 patients received epsilon-aminocaproic acid (EACA). Patients received TXA or EACA intraoperatively in two doses. Estimated blood loss, a change in hemoglobin and blood volume, postoperative drain output and transfusion rate were among the outcome measures assessed. Other outcomes included postoperative complications after 90 days and length stay. Based on a power analysis, 200 patients were needed to find a 10% difference; but due to a shortage of EACA, enrollment of the study stopped.
Results showed patients who received EACA compared with TXA had greater drain output, blood volume loss and hemoglobin decrease. However, no difference was seen between treatment groups with regard to the intraoperative estimated blood loss. One patient who received EACA required a transfusion, but this finding was not statistically significant. Postoperative complications and length of stay were not different between the treatment groups. – by Monica Jaramillo
Reference:
Bradley KE, et al. Abstract 594. Presented at: the American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.
Disclosure: Bradley reports no relevant financial disclosures.