The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis
Objective The optimal dose and efficacy of tranexamic acid (TXA) and epsilon‐aminocaproic acid (EACA) in total knee arthroplasty (TKA) were under controversial, and we aimed to make comparisons between different doses of TXA and EACA in intravenous (IV) or intra‐articular (IA) applications in patien...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13678 |
| _version_ | 1827967580284911616 |
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| author | Che Zheng Jun Ma Jiawen Xu Mingyang Li Liming Wu Yuangang Wu Yuan Liu Bin Shen |
| author_facet | Che Zheng Jun Ma Jiawen Xu Mingyang Li Liming Wu Yuangang Wu Yuan Liu Bin Shen |
| author_sort | Che Zheng |
| collection | DOAJ |
| description | Objective The optimal dose and efficacy of tranexamic acid (TXA) and epsilon‐aminocaproic acid (EACA) in total knee arthroplasty (TKA) were under controversial, and we aimed to make comparisons between different doses of TXA and EACA in intravenous (IV) or intra‐articular (IA) applications in patients undergoing TKA. Methods This network meta‐analysis was guided by the Priority Reporting Initiative for Systematic Assessment and Meta‐Analysis (PRISMA). According to the administrations of antifibrinolytic agents, patients in eligible studies were divided into three subgroups: (i) IA applications of TXA and EACA; (ii) IV applications (g) of TXA and EACA; (iii) IV applications (mg/kg) of TXA and EACA. Total blood loss (TBL), hemoglobin (HB) drops and transfusion rates were the primary outcomes, while drainage volume, pulmonary embolism (PE) or deep vein thrombosis (DVT) risk were the secondary outcomes. A multivariate Bayesian random‐effects model was adopted in the network analysis. Results A total of 38 eligible trials with different regimens were assessed. Overall inconsistency and heterogeneity were acceptable. Taking all primary outcomes into account, 1.0–3.0 g TXA were most effective in IA applications, 1–6 g TXA and 10–14 g EACA were most effective in IV applications (g), while 30 mg/kg TXA and 150 mg/kg EACA were most effective in IV applications (mg/kg). None of the regimens showed increasing risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) compared with placebo. Conclusion 0 g IA TXA, 1.0 g IV TXA or 10.0 g IV EACA, as well as 30 mg/kg IV TXA or 150 mg/kg IV EACA were most effective and enough to control bleeding for patients after TKA. TXA was at least 5 times more potent than EACA. |
| first_indexed | 2024-04-09T18:08:41Z |
| format | Article |
| id | doaj.art-20d66b4e0de44188b5bcfeae63be5d42 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-04-09T18:08:41Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-20d66b4e0de44188b5bcfeae63be5d422023-04-14T04:21:19ZengWileyOrthopaedic Surgery1757-78531757-78612023-04-0115493094610.1111/os.13678The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysisChe Zheng0Jun Ma1Jiawen Xu2Mingyang Li3Liming Wu4Yuangang Wu5Yuan Liu6Bin Shen7Department of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaDepartment of Orthopaedics West China Hospital, Sichuan University Chengdu ChinaObjective The optimal dose and efficacy of tranexamic acid (TXA) and epsilon‐aminocaproic acid (EACA) in total knee arthroplasty (TKA) were under controversial, and we aimed to make comparisons between different doses of TXA and EACA in intravenous (IV) or intra‐articular (IA) applications in patients undergoing TKA. Methods This network meta‐analysis was guided by the Priority Reporting Initiative for Systematic Assessment and Meta‐Analysis (PRISMA). According to the administrations of antifibrinolytic agents, patients in eligible studies were divided into three subgroups: (i) IA applications of TXA and EACA; (ii) IV applications (g) of TXA and EACA; (iii) IV applications (mg/kg) of TXA and EACA. Total blood loss (TBL), hemoglobin (HB) drops and transfusion rates were the primary outcomes, while drainage volume, pulmonary embolism (PE) or deep vein thrombosis (DVT) risk were the secondary outcomes. A multivariate Bayesian random‐effects model was adopted in the network analysis. Results A total of 38 eligible trials with different regimens were assessed. Overall inconsistency and heterogeneity were acceptable. Taking all primary outcomes into account, 1.0–3.0 g TXA were most effective in IA applications, 1–6 g TXA and 10–14 g EACA were most effective in IV applications (g), while 30 mg/kg TXA and 150 mg/kg EACA were most effective in IV applications (mg/kg). None of the regimens showed increasing risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) compared with placebo. Conclusion 0 g IA TXA, 1.0 g IV TXA or 10.0 g IV EACA, as well as 30 mg/kg IV TXA or 150 mg/kg IV EACA were most effective and enough to control bleeding for patients after TKA. TXA was at least 5 times more potent than EACA.https://doi.org/10.1111/os.13678BleedingEpsilon‐Aminocaproic acidTotal knee arthroplastyTranexamic acidTransfusion |
| spellingShingle | Che Zheng Jun Ma Jiawen Xu Mingyang Li Liming Wu Yuangang Wu Yuan Liu Bin Shen The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis Orthopaedic Surgery Bleeding Epsilon‐Aminocaproic acid Total knee arthroplasty Tranexamic acid Transfusion |
| title | The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis |
| title_full | The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis |
| title_fullStr | The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis |
| title_full_unstemmed | The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis |
| title_short | The Optimal Dose, Efficacy and Safety of Tranexamic Acid and Epsilon‐Aminocaproic Acid to Reduce Bleeding in TKA: A Systematic Review and Bayesian Network Meta‐analysis |
| title_sort | optimal dose efficacy and safety of tranexamic acid and epsilon aminocaproic acid to reduce bleeding in tka a systematic review and bayesian network meta analysis |
| topic | Bleeding Epsilon‐Aminocaproic acid Total knee arthroplasty Tranexamic acid Transfusion |
| url | https://doi.org/10.1111/os.13678 |
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