Artikel
Aminocaproic acid for the reduction of blood loss in total knee arthroplasty
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Veröffentlicht: | 23. Oktober 2017 |
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Objectives: Total knee arthroplasty (TKA) is usually accompanied by a significant perioperative blood loss that often requires allogenic blood transfusion. The most frequently used antifibrinolytic agent in orthopaedics is tranexamic acid, the efficacy and safety of which is well known. Nevertheless there are only few clinical studies that evaluate the efficacy of aminocaproic acid (ACA) in reducing perioperative blood loss during TKA.
The purpose of this study was to assess the efficacy and safety of using ACA in decreasing blood loss and in reducing blood transfusion rates in TKA.
Methods: Prospective comparative randomized placebo - controlled clinical study was conducted. 80 patients undergoing TKA were randomly enrolled in two groups. Patients in the study group (n=43) received ACA (50 mg/ml solution) before using tourniquet during TKA in dose 100 mg/kg followed by continuous intravenous infusion (1 g/h during 3 hours). Patients in the control group (n=37) received normal saline as a placebo in the same volume as ACA.
Both groups were similar regarding gender ratio, age, weight, comorbidities, duration of surgery and prosthesis type.
The drainage blood loss during 24 h after TKA, hemoglobin concentration (preoperative and on the sixth day postoperatively), blood transfusions rates were estimated.
Statistical analysis was conducted with Statistica 10.0 using Student's t-test and Mann-Whitney U-test. Continuous data are represented as mean and standard deviation [mean (SD)]. As a statistic significance level p<0.05 was taken.
Results: The drainage blood loss during 24 h after TKA was 284 ml (120) in the study group and 647 ml (126) in the control group (P< 0.001). Preoperative hemoglobin concentration was 13.9 g/dL (1.2) in the study group and 13.6 g/dL (1.2) in the control group (p >0.05). On the sixth day postoperatively hemoglobin concentration was 11.5 g/dL (1.4) in the study group and 9.7 g/dL (1.8) in the control group (P<0.001). The difference between hemoglobin level preoperatively and on the sixth day postoperatively was 2.4 (1.3) in the study group and 3.9 (1.5) in the control group, respectively (P<0.001). 14 patients in the control group received allogenic blood transfusion (37.8%). The patients in the study group didn't require blood transfusion. There were no adverse events or complications connected with the usage of ACA.
Conclusion: Aminocaproic acid is effective and safety antifibrinolytic agent, which significant decreases blood loss and reduces blood transfusion rates in total knee arthroplasty.