AI Article Synopsis
- This study compares the effects and costs of two antifibrinolytic agents, ε-aminocaproic acid (EACA) and tranexamic acid (TXA), on reducing blood transfusion rates in total hip arthroplasty (THA).
- A review of 1,799 THA cases showed that both EACA and TXA significantly reduced the need for red blood cell transfusions compared to a control group with no antifibrinolytics.
- EACA was found to be as effective as TXA but at a much lower average cost per surgery, highlighting its potential as a preferable option in clinical practice.
Article Abstract
Background: 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.
Methods: Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network.
Results: 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.
Conclusion: 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.
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| http://dx.doi.org/10.1016/j.arth.2016.05.011 | DOI Listing |
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