Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty.
Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA.



Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network.



In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery.



Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery.
Eastern Virginia Medical School, Norfolk, Virginia.
Jessica L
JL
Churchill
Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
Kathleen E
KE
Puca
Department of Quality Management, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
Elizabeth S
ES
Meyer
Department of Pharmacy, Aurora West Allis Medical Center, West Allis, Wisconsin.
Matthew C
MC
Carleton
Department of Orthopedics, Aurora Advanced Healthcare, Grafton, Wisconsin.
Susan L
SL
Truchan
Department of Orthopedics, Aurora Advanced Healthcare, Grafton, Wisconsin.
Michael J
MJ
Anderson
D000368:Aged; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid; D015119:Aminocaproic Acid
antifibrinolytic therapy; blood conservation; total hip arthroplasty; tranexamic acid; transfusion; ε-aminocaproic acid