Alimujiang•Yusufu, Abuduwupuer•Haibier, Qin Qi, Liu Yuzhe, Zhang Qianlong, Ran Jian
Department of Trauma and Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
Abstract: BACKGROUND: Antifibrinolytic drugs are widely used to reduce blood loss in total knee arthroplasty. Although the hemostatic effect of tranexamic acid and aminocaproic acid in total knee arthroplasty has been confirmed, which is superior or inferior is still controversial.
OBJECTIVE: To compare the safety and effectiveness of tranexamic acid and aminocaproic acid in the perioperative period of total knee arthroplasty.
METHODS: 102 patients undergoing unilateral total knee arthroplasty in the Sixth Affiliated Hospital of Xinjiang Medical University from April 2021 to June 2022 were retrospectively screened. These patients were divided into two groups according to different antifibrinolytic hemostatic agents applied during the perioperative period. Of these, 49 patients used aminhexic acid and 53 patients used tranexamic acid. Both groups received intravenous and topical combinations. The blood loss and coagulation indexes, postoperative hospital stay and postoperative complications in the perioperative period of total knee arthroplasty were compared between the two groups.
RESULTS AND CONCLUSION: (1) Preoperative data: No significant differences in age, gender composition, body mass index, hypertension, diabetes mellitus, operation time, erythrocytes, hemoglobin, hematocrit, albumin, prothrombin activity, international standard ratio, or D-dimer index were found between the two groups (P > 0.05). (2) Blood loss and coagulation indexes: There were significant differences in total blood loss and recessive blood loss between the tranexamic acid group and the aminocaproic acid group (P < 0.05). There was no significant difference in estimated blood volume, dominant blood loss and postoperative drainage between the two groups (P > 0.05). There was no significant difference in erythrocyte, hemoglobin, hematocrit, albumin, serum ferritin, D-dimer, prothrombin activity and international standard between the two groups at 1 and 5 days after operation (P > 0.05). (3) Blood transfusion: The amount of blood transfusion in the tranexamic acid group was significantly less than that in the aminocaproic acid group (P < 0.05), but there was no significant difference in blood transfusion rate between the two groups (P > 0.05). (4) There was no significant difference in postoperative hospital stay and postoperative complications between the two groups (P < 0.05). (5) The results showed that the hemostatic effect of tranexamic acid in the perioperative period of total knee arthroplasty was stronger than that of aminocaproic acid, and the safety of the two drugs was basically the same. Therefore, the authors suggest that tranexamic acid should be the first choice as an antifibrinolytic hemostatic drug in the perioperative period of total knee arthroplasty.
Key words: tranexamic acid, aminocaproic acid, total knee arthroplasty, blood loss, knee osteoarthritis