Topically applied epsilon-aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty

Robert A. Harper, Mark G. Sucher, Mauro Giordani, Alexander J. Nedopil

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (Ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of Ε-ACA to the open wound after tourniquet release and before closure (Ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of Ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (Ε-ACA-before-tourniquet-release group). The last 80 patients not receiving Ε-ACA (control group), the 80 patients in the Ε-ACA-after-tourniquet-release group, and the 80 patients in the Ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the Ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the Ε-ACA-before-tourniquet-release group (P<.05). Using Ε-ACA before tourniquet release reduced the length of hospital stay by 0.7 days (P<.05) compared with not using Ε-ACA, leading to cost savings of $1547.37 per patient. One patient in the Ε-ACA-before-tourniquet-release group and 1 patient in the control group developed a venous thromboembolism in the postoperative period. Epsilon-aminocaproic acid significantly reduces blood loss after TKA when topically applied before tourniquet release. Its application reduced costs by decreasing the length of hospital stay and did not increase thromboembolic events.

Original languageEnglish (US)
Pages (from-to)e1044-e1049
JournalOrthopedics
Volume40
Issue number6
DOIs
StatePublished - Nov 1 2017

Fingerprint

Aminocaproic Acid
Tourniquets
Knee Replacement Arthroplasties
Length of Stay
Tranexamic Acid
Control Groups
Cost Savings
Venous Thromboembolism
Wounds and Injuries
Postoperative Period
Health Care Costs

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Topically applied epsilon-aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty. / Harper, Robert A.; Sucher, Mark G.; Giordani, Mauro; Nedopil, Alexander J.

In: Orthopedics, Vol. 40, No. 6, 01.11.2017, p. e1044-e1049.

Research output: Contribution to journalArticle

Harper, Robert A. ; Sucher, Mark G. ; Giordani, Mauro ; Nedopil, Alexander J. / Topically applied epsilon-aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty. In: Orthopedics. 2017 ; Vol. 40, No. 6. pp. e1044-e1049.
@article{a0349f199a4b40439dfbcf6f96ad89dd,
title = "Topically applied epsilon-aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty",
abstract = "Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (Ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of Ε-ACA to the open wound after tourniquet release and before closure (Ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of Ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (Ε-ACA-before-tourniquet-release group). The last 80 patients not receiving Ε-ACA (control group), the 80 patients in the Ε-ACA-after-tourniquet-release group, and the 80 patients in the Ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the Ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the Ε-ACA-before-tourniquet-release group (P<.05). Using Ε-ACA before tourniquet release reduced the length of hospital stay by 0.7 days (P<.05) compared with not using Ε-ACA, leading to cost savings of $1547.37 per patient. One patient in the Ε-ACA-before-tourniquet-release group and 1 patient in the control group developed a venous thromboembolism in the postoperative period. Epsilon-aminocaproic acid significantly reduces blood loss after TKA when topically applied before tourniquet release. Its application reduced costs by decreasing the length of hospital stay and did not increase thromboembolic events.",
author = "Harper, {Robert A.} and Sucher, {Mark G.} and Mauro Giordani and Nedopil, {Alexander J.}",
year = "2017",
month = "11",
day = "1",
doi = "10.3928/01477447-20170925-07",
language = "English (US)",
volume = "40",
pages = "e1044--e1049",
journal = "Orthopedics",
issn = "0147-7447",
publisher = "Slack Incorporated",
number = "6",

}

TY - JOUR

T1 - Topically applied epsilon-aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty

AU - Harper, Robert A.

AU - Sucher, Mark G.

AU - Giordani, Mauro

AU - Nedopil, Alexander J.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (Ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of Ε-ACA to the open wound after tourniquet release and before closure (Ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of Ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (Ε-ACA-before-tourniquet-release group). The last 80 patients not receiving Ε-ACA (control group), the 80 patients in the Ε-ACA-after-tourniquet-release group, and the 80 patients in the Ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the Ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the Ε-ACA-before-tourniquet-release group (P<.05). Using Ε-ACA before tourniquet release reduced the length of hospital stay by 0.7 days (P<.05) compared with not using Ε-ACA, leading to cost savings of $1547.37 per patient. One patient in the Ε-ACA-before-tourniquet-release group and 1 patient in the control group developed a venous thromboembolism in the postoperative period. Epsilon-aminocaproic acid significantly reduces blood loss after TKA when topically applied before tourniquet release. Its application reduced costs by decreasing the length of hospital stay and did not increase thromboembolic events.

AB - Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (Ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of Ε-ACA to the open wound after tourniquet release and before closure (Ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of Ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (Ε-ACA-before-tourniquet-release group). The last 80 patients not receiving Ε-ACA (control group), the 80 patients in the Ε-ACA-after-tourniquet-release group, and the 80 patients in the Ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the Ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the Ε-ACA-before-tourniquet-release group (P<.05). Using Ε-ACA before tourniquet release reduced the length of hospital stay by 0.7 days (P<.05) compared with not using Ε-ACA, leading to cost savings of $1547.37 per patient. One patient in the Ε-ACA-before-tourniquet-release group and 1 patient in the control group developed a venous thromboembolism in the postoperative period. Epsilon-aminocaproic acid significantly reduces blood loss after TKA when topically applied before tourniquet release. Its application reduced costs by decreasing the length of hospital stay and did not increase thromboembolic events.

UR - http://www.scopus.com/inward/record.url?scp=85034018758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034018758&partnerID=8YFLogxK

U2 - 10.3928/01477447-20170925-07

DO - 10.3928/01477447-20170925-07

M3 - Article

C2 - 28968480

AN - SCOPUS:85034018758

VL - 40

SP - e1044-e1049

JO - Orthopedics

JF - Orthopedics

SN - 0147-7447

IS - 6

ER -