Tranexamic Acid versus Epsilon-Aminocaproic Acid in Total Knee Arthroplasty: A Meta-Analysis.

Zhihui Li,Xiaotong Sun,Weihua Li,Minghui Zhang,Malik Alazzam

doi:10.1155/2021/1758066

Abstract

Objective At present, the effect of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) on total knee arthroplasty (TKA) remains controversial. Therefore, the aim of this meta-analysis is to compare the differences between the effects of TXA and EACA in TKA. Methods We used electronic databases, including PubMed, Embase, MEDLINE, Ovid, ScienceDirect, Cochran Library, Google Scholar, clinical trial, and Chinese related databases, for literature search to find any effect of TXA and EACA in TKA. The differences between groups were compared by odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (CI). A total of four studies, including 3 randomized controlled trials (RCT) and 1 cohort study, were involved in this meta-analysis, involving 1836 participants. Among these participants, 816 belonged to the TXA group and 1020 belonged to the EACA group. Results Meta-analysis indicated no difference in surgery time (WMD = 0.01, 95% CI −0.35 to 0.36), total amount of blood loss (WMD = 0.14, 95% CI −0.09 to 0.37), transfusion rate (OR = 0.74, 95% CI 0.20 to 2.78), transfusion units per patient (SMD = −0.15, 95% CI −0.54 to 0.25), complications (OR = 0.75, 95% CI 0.37 to 1.55), and length of stay (SMD = −0.01, 95% CI −0.11 to 0.08). Conclusions Our results suggest that the effect of TXA is not superior to EACA in TKA. However, this conclusion still needs to be further confirmed by multicenter and large-sample clinical trials.

Highlights

Total knee arthroplasty (TKA) is the most effective and widely used surgical method for the treatment of patients with advanced osteoarthritis [1,2,3]
Camarasa et al [21] and Boese et al [22] found that tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) had no statistical difference in reducing the bleeding volume and blood transfusion rate during the TKA process
Databases used included PubMed, Embase, MEDLINE, Ovid, ScienceDirect, Cochran Library, Google Scholar, clinical trial, and Chinese related databases. e literature search included studies where TXA and EACA were used for TKA, and the search time was between the date of the establishment of the database to May 1, 2020

Summary

Introduction

Total knee arthroplasty (TKA) is the most effective and widely used surgical method for the treatment of patients with advanced osteoarthritis [1,2,3]. Camarasa et al [21] and Boese et al [22] found that TXA and EACA had no statistical difference in reducing the bleeding volume and blood transfusion rate during the TKA process. A recent randomized controlled trial (RCT) found that EACA was associated with increased perioperative blood loss compared to TXA in the TKA process [24].

Results

Conclusion