Comparison between epsilon-aminocaproic acid and tranexamic acid for total hip and knee arthroplasty: A meta-analysis

Background: The aim was to compare the efficacy and safety of epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Potential academic articles were identified from the Cochrane Library, Springer, PubMed, and ScienceDirect databases from inception to December 2019. Randomized controlled trials (RCTs) and non-RCTs involving EACA and TXA in THA or TKA were included. Pooled data were analyzed using RevMan 5.1. Results: Three RCTs and three non-RCTs met the inclusion criteria. The present meta-analysis reveals that EACA is associated with significantly more blood loss than TXA. No significant differences were identified in terms of blood transfusion rate, transfusion units, hemoglobin (Hb) level at discharge, operation time, length of hospital stay, deep venous thrombosis (DVT), or 30-day readmission. Conclusions: Compared with TXA, EACA led to more blood loss in patients undergoing THA or TKA. However, there was no significant difference in the blood transfusion rate, transfusion units, Hb level at discharge, operation time, length of hospital stay, DVT, or 30-day readmission between groups.

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The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01983-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Wei Ye ◽

Yafang Liu ◽

Wei Feng Liu ◽

Xiao Long Li ◽

Jianshu Shao

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Transfusion Rate ◽

Total Knee ◽

Knee And Hip Arthroplasty ◽

Primary Total Knee ◽

Optimal Regimen ◽

Better Than

Abstract Background Oral tranexamic acid (TXA) has been demonstrated to reduce the blood loss in primary total knee and hip arthroplasty, but the optimal regimen of oral TXA administration is still unknown. This study aimed to find the best number of administrations of oral TXA for primary total knee and hip arthroplasty. Methods The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published before March 20, 2020. Studies clearly reporting a comparison of multiple administrations of oral TXA for total hip/knee replacement were included, and the total blood loss (TBL), intraoperative blood loss (IBL), decline in hemoglobin (DHB), deep vein thrombosis (DVT), intramuscular venous thrombosis (IVT), length of hospital stay (LOS), and transfusion rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed effects or random effects model. Results Nine studies involving 1678 patients were included in this meta-analysis (TXA 1363 (one administration, 201; two administrations, 496; three administrations, 215; four administrations, 336; five administrations, 115); placebo 315); the results show that compared with placebo groups, oral TXA could significantly reduce the TBL, IBL, DHB, LOS, and transfusion rate. In addition, the incidences of IVT and DVT were similar between the TXA and placebo groups. Moreover, two administrations of oral TXA significantly reduced the TBL and DHB compared with one administration, three administrations of oral TXA were better than two administrations, and four administrations of oral TXA were better than three administrations. Conclusion Our results suggested that oral TXA could significantly reduce the blood loss and the length of hospital stay but could not increase the incidence of DVT and IVT for total joint replacement patients; additionally, the effectiveness of oral TXA administration increased as the number of administrations increased.

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

Journal of Healthcare Engineering ◽

10.1155/2021/1758066 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Zhihui Li ◽

Xiaotong Sun ◽

Weihua Li ◽

Minghui Zhang

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Aminocaproic Acid ◽

Transfusion Rate ◽

Randomized Controlled ◽

Total Knee ◽

Epsilon Aminocaproic Acid

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.

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Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

BioMed Research International ◽

10.1155/2020/7403034 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Zhencheng Xiong ◽

Junyuan Liu ◽

Ping Yi ◽

Hao Wang ◽

Mingsheng Tan

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Meta Analysis ◽

Cochrane Library ◽

Optimal Dosage ◽

Transfusion Rate ◽

Total Blood ◽

Surgical Methods

Objective. Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. Methods. We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Handbook. Results. Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = −0.39, 95% CI: [−0.63, −0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P<0.0001). Conclusion. During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.

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Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/0300060520917563 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091756

Author(s):

Zhenghao Wang ◽

Xiao He ◽

Yunjin Bai ◽

Jia Wang

Keyword(s):

Systematic Review ◽

Blood Transfusion ◽

Tranexamic Acid ◽

Percutaneous Nephrolithotomy ◽

Selection Process ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

Transfusion Rate ◽

Substantial Impact

Objective A systematic review and meta-analysis was conducted to explore the efficacy of tranexamic acid (TXA) in reducing transfusion events in patients undergoing percutaneous nephrolithotomy (PCNL). Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases from January 1980 to October 2019 were searched for randomized controlled trials (RCTs) that assessed TXA efficacy in reducing transfusion events during PCNL. Intervention treatments include using TXA compared with placebo (or no intervention) for patients who underwent PCNL. The search strategy and study selection process were managed in accordance with the PRISMA statement. Results Six RCTs are included in the meta-analysis. Overall, TXA intervention groups showed a significant reduction in blood transfusion events (RR = 0.34; 95% confidence interval [CI] = 0.19 to 0.62), hemoglobin decrease (MD = −0.80; 95% CI = −1.32 to −0.28), operative time (MD = −12.62; 95% CI = −15.62 to −9.61), and length of hospital stay (MD = −0.73; 95% CI = −1.36 to −0.10) compared with control groups after PCNL. However, TXA had no substantial impact on the rate of stone clearance (RR = 1.10; 95% CI = 1.00 to 1.21). Conclusions TXA can effectively reduce the transfusion rate and blood loss during PCNL.

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Faculty Opinions recommendation of The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158157.618267 ◽

2009 ◽

Author(s):

Jefferson Piva

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Pediatric Surgery ◽

Meta Analysis ◽

Aminocaproic Acid ◽

Blood Products

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The Efficacy and Safety of Fibrin Sealant Versus Tranexamic Acid Administration in Patients Undergoing Hip Arthroplasty: A Meta-analysis

10.21203/rs.3.rs-101441/v1 ◽

2020 ◽

Author(s):

Fan Yong Yong ◽

deng bo ◽

Hong Hai Nan ◽

Zhu Zhong

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Randomized Controlled Trials ◽

Hip Arthroplasty ◽

Fibrin Sealant ◽

Meta Analysis ◽

Controlled Trials ◽

Transfusion Rate ◽

Efficacy And Safety ◽

Randomized Controlled

Abstract PurposeThe efficacy and safety of topical fibrin sealant (FS) compared with tranexamic acid (TXA) to reduce blood loss after total hip arthroplasty (THA) is not clear. A meta-analysis was conducted to evaluate the efficacy and safety of topical FS versus topical or intravenous TXA for treatment of primary THA.MethodWe searched electronic databases, including PubMed, Embase, and the Cochrane Library to identify studies up to March 2020. The references included in articles were also checked for additional potentially-relevant studies. The language of publication was limited to English. The endpoints included the mean difference (MD) of blood loss, hemoglobin value, and odds ratios (ORs) of transfusion requirements and thrombotic events. Our meta-analysis was performed according to the Guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The data of the included studies were analyzed using RevMan 5.3.ResultsA total of four studies (two randomized controlled trials and two non-randomized controlled trials) met the inclusion criteria. Our meta-analysis demonstrated that TXA administration led to significantly different outcomes in terms of transfusion rate (RD = -0.12, 95% CI (-0.23, -0.00), P = 0.05, I2 = 74%) and postoperative hemoglobin levels (WMD = -0.47, 95% CI (-0.74, -021), P = 0.0005, I2 = 3%) compared with topical application of FS in patients undergoing THA. No significant difference was seen in total calculated blood loss (WMD = -86.22, 95% CI (-99.13, -73.31), P < 0.00001, I2 = 96%) or complication rate (RR = 0.98, 95% CI (-99.13, -73.31), P = 0.45, I2 = 0%) between the two groups.ConclusionsTXA administration can effectively decrease the transfusion rate and result in higher postoperative hemoglobin levels without increasing the rate of infection.

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Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

Plastic Surgery ◽

10.1177/2292550320925897 ◽

2020 ◽

Vol 28 (2) ◽

pp. 94-104

Author(s):

Liang Sun ◽

Rui Guo ◽

Yi Feng

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Orthognathic Surgery ◽

Operation Time ◽

Controlled Trials ◽

Allogenic Blood Transfusion ◽

Intraoperative Blood Loss ◽

Irrigation Fluid ◽

Allogenic Blood

Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

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Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02010-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yimin Zhang ◽

Bao Lang ◽

Guifeng Zhao ◽

Fengming Wang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Study Results ◽

Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

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Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040914 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040914

Author(s):

Kenta Ishii ◽

Yukihiro Yokoyama ◽

Yoshihiko Yonekawa ◽

Tomoki Ebata

Keyword(s):

Placebo Group ◽

Blood Loss ◽

Tranexamic Acid ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Operation Time ◽

Skin Incision ◽

Research Review ◽

Registration Number ◽

Poor Outcomes

IntroductionPancreaticoduodenectomy (PD) is a major gastroenterological surgery that results in a substantial amount of blood loss. Several studies have demonstrated that major blood loss during PD is associated with both short-term and long-term poor outcomes. Administration of perioperative tranexamic acid (TXA) has been reported to reduce intraoperative blood loss in various surgeries, including cardiovascular surgery and orthopaedic surgery. Nevertheless, the effect of perioperative TXA use in patients undergoing PD has not been investigated. This study aims to investigate the effect of TXA on blood loss during PD.Methods and analysisA multicentre (six hospitals), randomised, blind (patient-blinded, surgeon-blinded, anaesthesiologist-blinded, monitor-blinded), placebo-controlled trial of TXA during PD was started in September 2019. Patients undergoing PD for biliary, duodenal or pancreatic diseases are randomly assigned to the TXA or placebo group. The stratification factors are the institutions and preoperative clinical diagnosis. Before skin incision, the participants in TXA group are administrated 1 g TXA as a loading infusion followed by a maintenance infusion of 125 mg/hour TXA until the end of surgery or 8 hours from the incision. Participants in the placebo group are administrated the same volume of saline that is indistinguishable from the TXA. The primary outcome is blood loss during PD. The secondary outcomes are intraoperative and postoperative (up to day 2) blood transfusions, operation time, anaesthesia time, postoperative laboratory variables, length of hospital stay, in-hospital and 90-day mortality and postoperative complications occurring within 28 days of surgery or requiring readmission. To date, 115 patients of a planned 220 have been enrolled in the study.Ethics and disseminationThis protocol was approved by the Nagoya University Clinical Research Review Board and is registered with Japan Registry of Clinical Trials on 15 August 2019. The results of this trial will be disseminated through peer-reviewed journals.Trial registration numberjRCTs041190062.

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