Top

International Orthopaedics

Published in:

01-10-2016 | Original Paper

Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid

Authors: Mark G. Sucher, Mauro Giordani, Andrew Figoni, Alexander J. Nedopil

Published in: International Orthopaedics | Issue 10/2016

Abstract

Purpose

To evaluate the peri-operative blood loss with the use of epsilon-aminocaproic acid (ε-ACA) in total hip arthroplasty (THA).

Methods

One hundred sixty patients treated with THA were followed; 5 g ε-ACA diluted in 100 ml normal saline was applied intra-operatively. Eighty patients not receiving ε-ACA (non ε-ACA group) and eighty patients receiving ε-ACA (ε-ACA group) were compared regarding blood loss, need of transfusion, and thrombo-embolic complications.

Results

Blood loss (mean ± SD) for the non ε-ACA group was 1678 ± 515 ml and for the ε-ACA group 1403 ± 417 ml (p < 0.05). In the non ε-ACA group 23 patients needed blood transfusions compared to ten patients in the ε-ACA group (p < 0.05). Cost savings were $284.39 per patient. No patient in either group developed a thrombo-embolic complication.

Conclusions

This study demonstrates a significant reduction in peri-operative blood loss after THA with topically applied ε-ACA. The application of ε-ACA reduced costs by lowering transfusion rates and did not increase thrombo-embolic events. ε-ACA is safe and effective in reducing blood loss and cost-efficient in THA.

Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, Cremers S, Abraham IL, Investigation O (2003) Orthopedic surgery transfusion hemoglobin european overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43(4):459–469CrossRefPubMed

Johansson T, Pettersson LG, Lisander B (2005) Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop 76(3):314–319PubMed

Risberg B (1985) The response of the fibrinolytic system in trauma. Acta Chir Scand Suppl 522:245–271PubMed

Chapin JC, Hajjar KA (2015) Fibrinolysis and the control of blood coagulation. Blood Rev 29(1):17–24. doi:10.1016/j.blre.2014.09.003 CrossRefPubMed

Morais S, Ortega-Andreu M, Rodriguez-Merchan EC, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Zalve R, Gomez-Barrena E (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38(2):347–354. doi:10.1007/s00264-013-2188-7 CrossRefPubMed

Ishida K, Tsumura N, Kitagawa A, Hamamura S, Fukuda K, Dogaki Y, Kubo S, Matsumoto T, Matsushita T, Chin T, Iguchi T, Kurosaka M, Kuroda R (2011) Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 35(11):1639–1645. doi:10.1007/s00264-010-1205-3 CrossRefPubMedPubMedCentral

Iwai T, Tsuji S, Tomita T, Sugamoto K, Hideki Y, Hamada M (2013) Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty. Int Orthop 37(3):441–445. doi:10.1007/s00264-013-1787-7 CrossRefPubMedPubMedCentral

Irisson E, Hemon Y, Pauly V, Parratte S, Argenson JN, Kerbaul F (2012) Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery. Orthop Traumatol Surg Res 98(5):477–483. doi:10.1016/j.otsr.2012.05.002 CrossRefPubMed

Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, Ker K (2011) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 1:CD001886. doi:10.1002/14651858.CD001886.pub3 PubMed

10.

Wang M, Zheng XF, Jiang LS (2015) Efficacy and safety of antifibrinolytic agents in reducing perioperative blood loss and transfusion requirements in scoliosis surgery: a systematic review and meta-analysis. PLoS One 10(9):e0137886. doi:10.1371/journal.pone.0137886 CrossRefPubMedPubMedCentral

11.

Eubanks JD (2010) Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 18(3):132–138CrossRefPubMed

12.

Martin K, Knorr J, Breuer T, Gertler R, Macguill M, Lange R, Tassani P, Wiesner G (2011) Seizures after open heart surgery: comparison of epsilon-aminocaproic acid and tranexamic acid. J Cardiothorac Vasc Anesth 25(1):20–25. doi:10.1053/j.jvca.2010.10.007 CrossRefPubMed

13.

Ipema HJ, Tanzi MG (2012) Use of topical tranexamic acid or aminocaproic acid to prevent bleeding after major surgical procedures. Ann Pharmacother 46(1):97–107. doi:10.1345/aph.1Q383 CrossRefPubMed

14.

Tan J, Chen H, Liu Q, Chen C, Huang W (2013) A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res 184(2):880–887. doi:10.1016/j.jss.2013.03.099 CrossRefPubMed

15.

Camarasa MA, Olle G, Serra-Prat M, Martin A, Sanchez M, Ricos P, Perez A, Opisso L (2006) Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 96(5):576–582. doi:10.1093/bja/ael057 CrossRefPubMed

16.

Harley BJ, Beaupre LA, Jones CA, Cinats JG, Guenther CR (2002) The effect of epsilon aminocaproic acid on blood loss in patients who undergo primary total hip replacement: a pilot study. Can J Surg 45(3):185–190PubMedPubMedCentral

17.

Ray M, Hatcher S, Whitehouse SL, Crawford S, Crawford R (2005) Aprotinin and epsilon aminocaproic acid are effective in reducing blood loss after primary total hip arthroplasty—a prospective randomized double-blind placebo-controlled study. J Thromb Haemost 3(7):1421–1427. doi:10.1111/j.1538-7836.2005.01457.x

18.

Tuttle JR, Ritterman SA, Cassidy DB, Anazonwu WA, Froehlich JA, Rubin LE (2014) Cost benefit analysis of topical tranexamic acid in primary total hip and knee arthroplasty. J Arthroplasty 29(8):1512–1515. doi:10.1016/j.arth.2014.01.031 CrossRefPubMed

19.

Breda JR, Gurian DB, Breda AS, Meneghine A, Freitas AC, Matos LL, Abreu LC, Pires AC (2009) Topical use of antifibrinolytic agent to reduce postoperative bleeding after coronary artery bypass surgery. Rev Bras Cir Cardiovasc 24(3):341–345CrossRefPubMed

20.

Wang H, Shen B, Zeng Y (2015) Blood loss and transfusion after topical tranexamic acid administration in primary total knee arthroplasty. Orthopedics 38(11):e1007–1016. doi:10.3928/01477447-20151020-10 CrossRefPubMed

21.

Martin JG, Cassatt KB, Kincaid-Cinnamon KA, Westendorf DS, Garton AS, Lemke JH (2014) Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty 29(5):889–894. doi:10.1016/j.arth.2013.10.005 CrossRefPubMed

22.

Abul-Azm A, Abdullah KM (2006) Effect of topical tranexamic acid in open heart surgery. Eur J Anaesthesiol 23(5):380–384. doi:10.1017/S0265021505001894 CrossRefPubMed

23.

Krohn CD, Sorensen R, Lange JE, Riise R, Bjornsen S, Brosstad F (2003) Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl 588:57–61PubMed

24.

Lemay E, Guay J, Cote C, Roy A (2004) Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anaesth 51(1):31–37. doi:10.1007/BF03018543 CrossRefPubMed

25.

So-Osman C, Nelissen R, Brand R, Faber F, Slaa RT, Stiggelbout A, Brand A (2013) The impact of a restrictive transfusion trigger on post-operative complication rate and well-being following elective orthopaedic surgery: a post-hoc analysis of a randomised study. Blood Transfus 11(2):289–295. doi:10.2450/2013.0172-12 PubMedPubMedCentral

26.

Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232PubMed

27.

Johansson T, Lisander B, Ivarsson I (1999) Mild hypothermia does not increase blood loss during total hip arthroplasty. Acta Anaesthesiol Scand 43(10):1005–1010CrossRefPubMed

28.

Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W (2009) Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res 123(5):687–696. doi:10.1016/j.thromres.2008.09.015 CrossRefPubMed

29.

Ortmann E, Besser MW, Klein AA (2013) Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth 111(4):549–563. doi:10.1093/bja/aet154 CrossRefPubMed

Title: Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid
Authors: Mark G. Sucher
Mauro Giordani
Andrew Figoni
Alexander J. Nedopil
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-3103-1

At a glance: The STEP trials

Springer Medicine

Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2016

Epidemiologic data and trends concerning the use of regional anaesthesia for shoulder arthroscopy in the United States of America

Part 2: outcome of acetabular fractures and associated prognostic factors—a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation

Adolescent idiopathic scoliosis: evidence for intrinsic factors driving aetiology and progression

No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome

Short to mid-term results of stemless reverse shoulder arthroplasty in a selected patient population compared to a matched control group with stem

Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation