Epsilon-aminocaproic Acid Group Research Articles

Efficacy and safety of using aminocaproic acid and tranexamic acid during the perioperative period for treating trochanteric fractures in elderly femurs

BackgroundTranexamic acid (TXA) has long been the antifibrinolytic hemostatic drug of choice for orthopedic surgery. In recent years, the hemostatic effect of epsilon aminocaproic acid (EACA) has gradually been recognized by orthopedic surgeons and has begun to be used in hip and knee arthroplasty with little mention of the comparison of these two drugs; Therefore, this study compared the efficacy and safety of EACA and TXA in the perioperative period of elderly patients with trochanteric fractures to verify whether EAC could be a "qualified alternative" to TXA and to provide theoretical support for the clinical application of TXA.MethodsTwo hundred and forty-three patients who received proximal femoral nail antirotation (PFNA) for trochanteric fractures from January 2021 to March 2022 at our institution were included and divided into the EACA group (n = 146) and the TXA group. (n = 97) determined by the drugs used in the perioperative period The main observations were blood loss and blood transfusion.The second second outcome was blood routine, coagulation, Hospital complications and complications after discharge.ResultsThe perioperative EACA patients had significantly lower significant blood loss (DBL) than the TXA group (p < 0.0001) and statistically significant lower C-reactive protein in the EACA group than in the TXA group on postoperative day 1 (p = 0.022). Patients on perioperative TXA had better postoperative day one (p = 0.002) and postoperative day five erythrocyte width than the EACA group (p = 0.004). However, there was no statistically significant difference between the two groups in the remaining indicators in both drugs: blood items, coagulation indicators, blood loss, blood transfusion, length of hospital(LOH), total hospital expense, and postoperative complications (p > 0.05).ConclusionThe hemostatic effects and safety of EACA and TXA in the perioperative application of trochanteric fractures in the elderly are essentially similar, and EACA can be considered for use as an alternative to TXA, increasing the flexibility of physicians to use it in the clinical setting. However, the limited sample size included necessitated a high-quality, large sample of clinical studies and long-term follow-up.

Epsilon aminocaproic acid is associated with acute kidney injury after life-threatening hemorrhage in children.

Antifibrinolytic medications have been associated with reduced mortality in pediatric hemorrhage but may contribute to adverse events such as acute kidney injury (AKI). We conducted a secondary analysis of the MAssive Transfusion in Children (MATIC), a prospectively collected database of children with life-threatening hemorrhage (LTH), and evaluated for risk of adverse events with either antifibrinolytic treatment, epsilon aminocaproic acid (EACA) or tranexamic acid (TXA). The primary outcome was AKI and secondary outcomes were acute respiratory distress syndrome (ARDS) and sepsis. Of 448 children included, median (interquartile range) age was 7 (2-15) years, 55% were male, and LTH etiology was 46% trauma, 34% operative, and 20% medical. Three hundred and ninety-three patients did not receive an antifibrinolytic (88%); 37 (8%) received TXA and 18 (4%) received EACA. Sixty-seven (17.1%) patients in the no antifibrinolytic group developed AKI, 6 (16.2%) patients in the TXA group, and 9 (50%) patients in the EACA group (p = .002). After adjusting for cardiothoracic surgery, cyanotic heart disease, preexisting renal disease, lowest hemoglobin pre-LTH, and total weight-adjusted transfusion volume during the LTH, the EACA group had increased risk of AKI (adjusted odds ratio 3.3 [95% CI: 1.0-10.3]) compared to no antifibrinolytic. TXA was not associated with AKI. Neither antifibrinolytic treatment was associated with ARDS or sepsis. Administration of EACA during LTH may increase the risk of AKI. Additional studies are needed to compare the risk of AKI between EACA and TXA in pediatric patients.

Combination of Intravenous and Intra-Articular Application of Tranexamic Acid and Epsilon-Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

There were limited randomized controlled trials (RCTs) of epsilon-aminocaproic acid (EACA) versus tranexamic acid (TXA) in total knee arthroplasty (TKA). The aim of the study was to compare the efficacy and safety of TXA and EACA in the combination of intravenous (IV) and intra-articular (IA) administration on reducing blood loss in patients following primary TKA. From January 2020 to January 2021, a total of 181 patients undergoing a primary unilateral TKA were enrolled in this prospective randomized controlled trial. Patients in the TXA group (n=90) received 20 mg/kg of intravenous TXA preoperatively, 1 g of intra-articular TXA intraoperatively, and three doses of 20 mg/kg intravenous TXA at 0, 3, 6 h postoperatively. Patients in the EACA group (n=91) received 120 mg/kg of intravenous EACA preoperatively, 2 g of intra-articular EACA intraoperatively, and three doses of 40 mg/kg intravenous EACA at 0, 3, 6 h postoperatively. The primary outcomes were total blood loss (TBL), transfusion rates and drop of hemoglobin (HB) level. The secondary outcomes included postoperative hospital stays and postoperative complications. The chi-square tests and Fisher's exact tests were utilized to compare categorical variables, while the independent-samples t-tests and Mann-Whitney tests were used to compare continuous variables. The patients who received TXA averaged less TBL than the patients who received EACA (831.83 ml vs 1065.49 ml, P=0.015), and HB drop in TXA group was generally less than that of EACA group on postoperative day 1 and 3 (20.84 ± 9.48 g/L vs 24.99 ± 9.40 g/L, P=0.004; 31.28 ± 11.19 vs 35.46 ± 12.26 g/L, P=0.047). The length of postoperative stays in EACA group was 3.66 ± 0.81day, which is longer than 2.62 ± 0.68day in TXA group (P < 0.001). No transfusions were required in either group. The risk of nausea and vomiting in TXA group was significantly higher than that in EACA group (11/90 vs 0/91, P < 0.01). Although the TBL and HB drop were slightly greater in EACA group, these results were not clinically important, given that no transfusions were required. EACA could be an alternative to TXA, especially for patients with severe nausea and vomiting after using TXA postoperatively. Further studies are needed to adjust dosage of EACA to make better comparison of the two drugs.

Tranexamic versus aminocaproic acids in patients with total hip arthroplasty: a retrospective study

BackgroundRecently, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) have been applied in total hip arthroplasty (THA). However, doubts in clinicians’ minds about which medicine is more efficient and economical in THA need to be clarified. Therefore, this study compared the efficacy and cost of the intraoperative administration of TXA and EACA per surgery in decreasing perioperative blood transfusion rates in THA.Methods This study enrolled patients who underwent THA between January 2019 to December 2020. A total of 295 patients were retrospectively divided to receive topical combined with intravenous TXA (n = 94), EACA (n = 97) or control (n = 104). The primary endpoints included transfusions, estimated perioperative blood loss, cost per patient and the drop in the haemoglobin and haematocrit levels.ResultsPatients who received EACA had greater total blood loss, blood transfusion rates, changes in HGB levels and mean cost of blood transfusion per patient (P < 0.05) compared with patients who received TXA. In addition, both TXA and EACA groups had significantly fewer perioperative blood loss, blood transfusion, operation time and changes in haemoglobin and haematocrit levels than the control group (P < 0.05). Cost savings in the TXA and EACA groups were 736.00 RMB and 408.00 RMB per patient, respectively.ConclusionsThe application of perioperative antifibrinolytics notably reduces the need for perioperative blood transfusions. What’s more, this study demonstrated that TXA is superior to EACA for decreasing blood loss and transfusion rates while at a lower cost per surgery. These results indicate that TXA may be the optimum antifibrinolytics for THA in Chinese area rather than EACA.

Comparative Analysis of Topical Versus Intravenous Administration of Epsilon-Aminocaproic Acid on Blood Management in Total Knee Arthroplasty.

IntroductionAlthough the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA.MethodsThis cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay.ResultsOf the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001).ConclusionsThe topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.

Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III\u2013IV calcaneal fractures

PurposeTo investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures.MethodsPatients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes.ResultsThe volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications.ConclusionLocal administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.

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

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.

INTRAARTICULAR EPSILON AMINOCAPROIC ACID VERSUS TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY.

ABSTRACTObjective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

A comparitive study between tranexamic acid and epsilon-amino-caproic acid in reducing post-operative bleeding in patients undergoing on pump cabg surgeries.

The amount of strain that cardiac surgery exerts on blood bank services is an example that emphasises the need for multimodel blood conservation stratergy. The most common factor which is being attibutable to increased bleeding after cardiac surgery is hyperfibrinolysis. Thererfore the use of antifibrinolytics during high risk cardiac surgery becomes inevitable. Commonly used antifibrinolytic include Tranexamic Acid(TA) and Epsilon-amino-caproic acid (EACA) .The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries and to asses the post operative complications associated with its use.Material and Methods After obtaining informed written consent,approval of ethics and research commitee patients who were scheduled for on-pump CABG were included in the study.Patients were divided into two groups randomly by using a comupter generated randomized block design namely group TA(n=40) and group EACA (n=40). TA group received tranaxamic acid at a dose of 10mg/kg IV over 20 min at the time of induction then 1-2 mg/kg in CPB prime followed by 1 mg /kg/hr infusion during surgery. Group EACA received EACA in a dose of 100mg/kg/IV over 20 min at he time of induction then 5-10mg/kg in CPB prime followed by 10mg/kg/hr infusion during surgery . Pateints were assessed for blood loss and were monitored for fibrinogen level and D- dimer levels, Re-exploration and post operative complications. Result Primary outcomes like bleeding at 4hrs, there was no significant difference between the groups but when total bleeding at 24 hrs was compared there was a significantly lesser bleed in group TA group compared to group EACA (P=0.0022).The requirement of PRBC in group TA was for 3 patients,where as in EACA group 4 patients required PRBC (P&gt;0.05).There was no significant difference in the rate of post operative complications between the groups.(P&gt;0.05) .Conclusion from our study we concluded that both TA &amp; EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding.When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs.Our study also re emphesized the fact that neither of the drug led to any additional risk of post operative thrombotic complications.

Comparison of Blood-Conserving and Allogenic Transfusion-Sparing Effects of Antifibrinolytics in Scoliosis Correction Surgery.

Background:Intraoperative antifibrinolytic drug administration is a safe and effective method of reducing blood loss and allogenic transfusions in patients undergoing spine deformity correction.Aim:This study aimed to compare the effectiveness of two antifibrinolytic drugs tranexamic acid (TXA) and epsilon amino caproic acid (EACA) in reducing peri-operative blood loss and transfusion requirements against a placebo control in patients with idiopathic scoliosis undergoing correction surgery.Setting and Design:This is a prospective, randomized, double-blinded, controlled comparative study.Methodology:Patients in TXA group received 50 mg.kg−1 bolus and 10 mg.kg−1.h−1 infusion as against 100 mg.kg−1 and 10 mg.kg−1.h−1 infusion in EACA group. The placebo group had saline bolus and infusion. Parameters observed included baseline demographic and deformity data, duration of surgery, total peri-operative blood loss, and allogenic packed red cell transfusion requirements.Statistical Analysis:Mean and standard deviation were used to represent the quantitative continuous data, and percentage was used to represent categorical data. The Student's t-test and ANOVA were used to compare means between groups. Bonferroni's multiple comparison test was used to find out the association between categorical variables.Results:A total of 36 patients were enrolled with 12 patients in each group. Peri-operative blood loss was 50.1% lower in patients receiving TXA and 17.7% lower in patients receiving EACA compared with the placebo group. The volume of total packed red cell transfusion was 66.7% lower in patients receiving TXA and 45.6% lower in patients receiving EACA compared with placebo.Conclusion:TXA was more effective in reducing total peri-operative blood loss and allogenic transfusion requirement in idiopathic scoliosis correction surgery compared to EACA.

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

BackgroundAntifibrinolytic 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). MethodsIn 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. ResultsBoth 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. ConclusionIntraoperative administration of EACA significantly decreased the blood loss and postoperative transfusion rates compared with no antifibrinolytic therapy in bilateral simultaneous TKA.

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

IntroductionTotal knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [1]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery.Materials and methodsMEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics.ResultsThree studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) −0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI −0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI −0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI −0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI −0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61).ConclusionsThis study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA surgery.Level of evidence3.

Intravenous Tranexamic Acid Versus Topical Aminocaproic Acid: Which Method Has the Least Blood Loss and Transfusion Rates?

Introduction:Since the advent of antifibrinolytics, blood transfusions and their associated complications in total joint arthroplasty have decreased. Few studies have compared different antifibrinolytic types with respect to blood loss and transfusion rates. We sought to compare the blood loss and transfusion rates between epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), and control.Methods:A total of 564 patients underwent primary total hip or total knee arthroplasty at our institution. Patients were divided into 3 groups: 183 EACA, 204 TXA, and 177 control. Patient demographics, hemoglobin, transfusion rates, and blood loss were collected.Results:Patient preoperative variables were similar. The control group had a mean estimated blood loss (EBL) of 1.48 L, with 51 units of packed red blood cells (pRBCs) given and 14.7% of patients receiving a blood transfusion. The EACA group had an EBL of 1.33 L, with 20 pRBCs given and 10.9% of patients receiving a transfusion. The TXA group had an EBL of 1.05 L, with 3 pRBCs transfused in 0.98% of patients. Compared with the control group, blood loss (P = 0.0014; P < 0.0001), number of pRBCs given (P = 0.007; P < 0.0001), and number of patients transfused (P = 0.012; P < 0.0001) were significantly lower in the EACA and TXA groups, respectively. TXA had significantly lower blood loss (P < 0.0001), lower number of tranfusions (P = 0.005), and less patients transfused (P = 0.003) compared with EACA.Conclusion:Our study reports lower blood loss, transfusion rates, and number of patients needing transfusion with both EACA and TXA in the setting of total joint arthroplasty. When comparing between EACA and TXA, TXA had lower blood loss, transfusion rates, and number of patients requiring transfusion.

Blood Conservation Using Tranexamic Acid Is Not Superior to Epsilon-Aminocaproic Acid After Total Knee Arthroplasty.

Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are synthetic amino acid derivatives that interfere with fibrinolysis, promoting hemostasis by pharmacological means. Although both drugs have been shown to decrease blood loss with a minimal risk of thromboembolic adverse events following cardiac and vascular surgery, we are aware of only 1 published trial that directly compared the antifibrinolytic effects of EACA with those of TXA after total knee arthroplasty (TKA). The primary aim of this prospective, randomized, controlled trial was to determine whether TXA provides superior blood conservation following TKA compared with that provided by EACA. A total of 194 patients scheduled to undergo a primary unilateral TKA in the same community-based hospital were prospectively randomized to receive intravenous EACA (n = 96) or TXA (n = 98). Both the patients and the operating surgeons were blinded to the treatment assignments. Primary outcome measures included transfusions, estimated blood loss, and the drop in the hemoglobin (Hgb) level. Secondary outcomes measures included the change in the serum creatinine level, postoperative complications, and length of hospital stay. Although the patients who received TXA averaged less estimated blood loss than the patients who received EACA (t185 = 2.18, p = 0.031; mean difference = 144.2 mL, 95% confidence interval = 13.62 to 274.78 mL), no transfusions were required in either group. We observed no statistically significant or clinically relevant between-group differences in the change in Hgb or serum creatinine level, postoperative complications, or length of hospital stay. Although the estimated blood loss was significantly greater in the EACA group, no transfusions were required and no significant between-group differences were observed for any other outcomes measured. We concluded that EACA may be an acceptable alternative to TXA for blood conservation following TKA, although replication of our results in noninferiority trials is necessary. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Epsilon Aminocaproic Acid to Reduce Blood Loss and Transfusion After Total Hip and Total Knee Arthroplasty

BackgroundTotal hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothesis that epsilon aminocaproic acid (EACA) can reduce blood loss and transfusion after joint arthroplasty. MethodsIn April 2014, our Veterans Affairs Medical Center introduced a protocol to administer EACA during THA and TKA. No antifibrinolytics were used previously. We retrospectively compared blood loss and incidence of transfusion among patients who underwent primary arthroplasty in the year before standardized administration of EACA with patients having the same procedures the following year. Blood loss was measured as delta hemoglobin (preoperative hemoglobin − hemoglobin on postoperative day 1). All patients undergoing primary THA or TKA were included. Patients having revision surgery were excluded. ResultsWe identified 185 primary arthroplasty patients from the year before and 184 from the year after introducing the EACA protocol. There were no changes in surgical technique or attending surgeons during this period. Delta hemoglobin was significantly lower in the EACA group (2.7 ± 0.8 mg/dL) compared to the control group (3.4 ± 1.1 mg/dL) (P < .0001). The incidence of blood transfusion was also significantly lower in the EACA group (2.7%) compared to the control group (25.4%) (P < .0001). There was no difference in venous thromboembolic complications between groups. ConclusionWe demonstrated reductions in hemoglobin loss and transfusion following introduction of the EACA protocol in patients undergoing primary arthroplasty. EACA offers a lower cost alternative to TXA for reducing blood loss and transfusion in this population.

Abstract 521: A Pilot Study Comparing Anti-Inflammatory Effects of Tranexamic Acid and Epsilon Aminocaproic Acid in Pediatric Congenital Heart Surgery

Background: Antifibrinolytic agents are frequently used during pediatric heart surgery with cardiopulmonary bypass (CPB) to reduce transfusions. There are no studies comparing anti-inflammatory effects of antifibrinolytic agents, tranexamic acid (TXA) and Epsilon Aminocaproic acid (EACA). We compared the two agents in pediatric patients undergoing redo sternotomy with CPB. Aim: To compare anti-inflammatory effects of tranexamic acid versus aminocaproic acid in pediatric patients undergoing redo sternotomy and cardiopulmonary bypass. Methods: We conducted a randomized, double blind pilot study, comparing 10 subjects in each group receiving EACA and TXA. A cytokine panel was used to measure 13 inflammatory markers in pre, immediate post and 24 hours post-CPB period. Between group comparisons were tested with Mann-Whitney U tests and within group comparisons with Friedman tests. Results: Sample characteristics were comparable in both groups. Post CPB, plasma levels of 7 markers increased significantly (p&lt;0.05) in both groups, including MCP-1; 3 increased significantly (p&lt;0.03) in the EACA group alone, including GM-CSF; and 3 did not change over time (Table 1). No difference was found between groups for markers except for IL-10, which was significantly higher in EACA group post CPB. While absolute values of markers, chest tube output and volume of blood product needs were lower in TXA group, the differences were not statistically significant. Conclusion: There was no significant difference in anti-inflammatory profiles between EACA and TXA in this pilot study. GM-CSF and MCP-1 were increased in our study post CBP which has not been described in previous studies.

The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery

Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.

Efficacy of antifibrinolytic agents on surgical bleeding and transfusion requirements in spine surgery: a meta-analysis.

Spine surgery is usually associated with large amount of blood loss and blood transfusion. Excessive blood loss may cause hypotension, inadequate oxygenation of organs, necessitate allogeneic blood transfusion, and spinal epidural hematoma formation. Aprotinin, TXA, and EACA are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The purpose of this study was to assess the efficacy of using antifibrinolytic agents in reducing blood loss and blood transfusions in spine surgery. PubMed, Embase, and Cochrane-controlled trials register were used to identify RCTs published before April 2015 that examined the effectiveness of intravenous aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) on reduction of blood loss and blood transfusions, compared with placebo in spine surgery. Randomized controlled trials reported the primary outcome that included total blood loss, intra-operative blood loss, post-operative blood loss, blood transfusion requirements, blood transfusion rate, and incidence of deep vein thrombosis. Meta-analysis was performed using the Stata12.0. Weighted mean difference with 95% confidence intervals was used to summarize the findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratios with 95% confidence intervals. A P<0.05 was considered statistically significant. 17 studies involving 1191 patients were identified. Among them, 13 RCTs with 943 patients were included for the evaluation of total blood loss. Compared with the control group, the antifibrinolytic agents reduced total blood loss (SMD=-0.62; 95% CI -0.75, -0.48; P=0.000), The aprotinin group (SMD=-0.80; 95% CI -1.22, -0.37; P=0.938), The TXA group (SMD=-0.75; 95% CI -0.93, -0.57; P=0.000), and the EACA group (SMD=-0.28; 95% CI -0.54, -0.01; P=0.185). Thirteen RCTs with eight hundred and ninety four patients were included for the evaluation of intra-operative blood loss. Compared with the control group, the antifibrinolytic agents reduced intra-operative blood loss (SMD=-0.41; 95% CI -0.55, -0.28; P=0.010), The aprotinin group (SMD=-0.62; 95% CI -0.93, -0.30; P=0.862), The TXA group (SMD=-0.47; 95% CI -0.64, -0.29; P=0.005), and the EACA group (SMD=-0.16; 95% CI -0.42, -0.11; P=0.897). Eight RCTs with six hundred and seven patients were included for the evaluation of post-operative blood loss. Compared with the control group, the antifibrinolytic agents reduced post-operative blood loss (SMD=-0.68; 95% CI -0.85, -0.51; P=0.000), the aprotinin group (SMD=-0.48; 95% CI -0.85, -0.12; P=0.036), the TXA group (SMD=-0.80; 95% CI -1.01, -0.59; P=0.000), and the EACA group (SMD=-0.32; 95% CI -0.68, -0.04; P=0.009). Ten RCTs with seven hundred and twenty twopatients were included for the evaluation of blood transfusion. Compared with the control group, the antifibrinolytic agents reduced blood transfusion (SMD=-0.68; 95% CI -0.85, -0.51; P=0.000), the aprotinin group (SMD=-0.80; 95% CI -1.22, -0.37; P=0.938), the TXA group (SMD=-0.38; 95% CI -0.58, -0.18; P=0.000), and the EACA group (SMD=-0.28; 95% CI -0.54, -0.01; P=0.185). Twelve RCTs with eight hundred and fifteenpatients were included for the evaluation of blood transfusion rate. The transfusion rate was 35.6% in the patients with antifibrinolytic agents and 55.2% in the patients with placebo (RR=0.75; 95% CI 0.63, 0.89; P=0.939). All studies were included for the evaluation of safety, with a total of eight thromboembolic events reported overall (two in the experimental group and six in the control group). The antifibrinolytic agents were able to reduce perioperative blood loss and transfusion requirements in spine surgery. TXA appeared more effective than aprotinin and EACA in reducing total blood loss, intra-operative blood loss, and blood transfusion according to the results of this analysis. The three groups in reducing the post-operative blood loss are significantly better than control groups. There was no evidence that the use of antifibrinolytic agents was a risk factor for thromboembolism in spine surgery. Further multicenter, large-sample, double-blind RCTs are required to confirm the efficacy and safety of the three antifibrinolytic agents in spine surgery.

Comparison of the Intraoperative Outcomes of Intrauterine Instillation of Epsilon-Aminocaproic Acid and Intravenous Oxytocin in Hysteroscopy Surgeries

Objectives:As the technique of choice, hysteroscopy can be used in visualizing and treating intrauterine pathologies such as polyps, septa, fibroids and endometrial hyperplasia. The best visualization, however, is attained when the endometrium is flat or atrophic; or a pre-existing active bleeding is minimal or suspended during hysteroscopy. Both epsilon-aminocaproic acid (EACA) and oxytocin have been found effective against active bleeding. The present work aimed to compare the efficacy and safety of intrauterine EACA and intravenous oxytocin in the management of intractable uterine bleeding in candidates of operative hysteroscopy. Materials and Methods:In this single-center, observer-blinded clinical trial, 144 candidates of operative hysteroscopy with intractable moderate uterine bleeding were randomized in two groups, receiving either intrauterine instillation of EACA (2 g in 1 L of 5% dextrose serum, n = 72) or intravenous oxytocin (10 IU/L, n = 72). The operator graded the severity of intraoperational bleeding (I = no to V = most severe). Serum hematocrit and hemoglobin changes, intra- and post-operational complications, the mean operative time, and the mean volume of the employed media were also recorded and compared between the two groups. Results: The two groups were comparable in terms of age, gravidity and parity. Grades I, II and III of intraoperational bleeding were reported in 79.2%, 18.1% and 2.8% of cases in the EACA group, and 18.2%, 65.3% and 16.7% of the cases in the oxytocin group, respectively (P < 0.001). While the two groups were also comparable in terms of serum hematocrit and hemoglobin changes, intra- and post-operation complications (none in both groups) and the mean volume of the media intraoperatively, the mean operative time was significantly shorter in patients who received intrauterine instillation of EACA (10.28 ± 3.24 minutes vs. 11.81 ± 4.62 minutes, P = 0.02). Conclusion:Owing to less severe intraoperative hemorrhage and shorter duration of operation in the group who received intrauterine instillation of EACA than those with intravenous injection of oxytocin, we recommend the intrauterine EACA in managing intractable uterine bleeding in candidates of hysteroscopy.

Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS)

ObjectiveMucosal bleeding during FESS often interferes with optimal visualization of the nasal surgical field and can impair the safety and efficiency of the procedure. This study was conducted to evaluate the efficacy of tranexamic acid and Epsilon Aminocaproic Acid to decrease bleeding and improve visualization of the surgical field during FESS.Materials and methodsA total of 90 patients ASA I-II aged from 18 to 50 years and undergoing FESS for chronic sinusitis were enrolled in this study. Surgery was performed under general anesthesia patients were randomly assigned to three equal groups (30 patients each), patients in TXA group received intravenous tranexamic acid 10 mg/kg diluted in 100 ml saline. EACA group received intravenous Epsilon Aminocaproic Acid 100 mg/kg diluted in 100 ml saline and the control group received IV 100 ml normal saline (all infusions were through 10 min). The duration of surgery, volume of blood loss, pre and postoperative hemoglobin, MAP and HR, surgical field quality surgeon satisfaction and side effects were recorded.ResultsThe duration of surgery was significantly less in TXA and EACA groups than the control group (121.1 ± 7.1 min), (120.8 ± 6.0 min), versus (146.1 ± 7.3 min) volume of blood loss in TXA group and EACA group was comparable (195.3 ± 32.2 ml) and (201.5 ± 30.6 ml) but each of them has significant less blood loss than the control group (365.1 ± 48.8 ml). The postoperative hemoglobin was significantly lower in the control group (11.9 ± 0.4 gm/dl) compared to TXA group (12.6 ± 0.2 gm/dl) and EACA group (12.4 ± 0.2 gm/dl). Both TXA and EACA groups had comparable improved quality of the surgical field with most of patients classified as grade 1 and 2 according to Boezaart scale while the control group had most of patients in grade 3, accordingly the surgeon satisfaction is significantly higher in TXA and EACA groups compared to the control group. No significant difference in side effects between all groups.ConclusionIntravenous tranexamic acid and Epsilon Aminocaproic Acid (EACA) effectively reduce bleeding during FESS and improve visualization of the surgical field and so increase the surgeon satisfaction with no significant difference between both drugs.