Comparative study of efficacy of reduction of blood loss by tranexamic acid and epsilon aminocaproic acid for orthopedic femoral surgeries
Abstract
Background: Femoral surgeries are always associated with excessive bleeding either in the intra-operative or postoperative period; often requiring blood transfusion. Induced hypotension and antifibrinolytics have been used to decrease blood loss. Agents used in this indication are the serine protease inhibitor aprotinin and the lysine analogues tranexamic acid (TA) and 1-aminocaproic acid. This study was designed to establish the efficacy of reduction of blood loss by TA verses epsilon-aminocaproic acid (EACA).
Methodology: The study was prospective, randomized and double blinded. 60 patients with written consent undergoing open femoral shaft surgeries were randomly allocated in Group T (receiving initial dose of 5.4 mg/kg of TA in intravenous route given over 20 min, followed by an infusion of 5 mg/kg/h till the end of the surgery) and Group E receiving initial dose of 100 mg/kg of EACA in intravenous route over 20 min, followed by an infusion of 1g/h till the end of surgery. Intra-operative and postoperative blood loss, intra-operative and postoperative blood transfusion, postoperative hemoglobin (Hb) on day 5 and any adverse effects were recorded.
Results: Intra-operative blood loss (mean ± SD) was 323.28 ± 45.282 ml in Group T and 411.67 ± 41.384 ml in Group E (p < 0.001). Postoperative blood loss was 134.48 ± 42.476 ml in Group T and 130.00 ± 44.721 ml in Group E. Intra-operative blood transfusion was 0.10 ± .310 units in Group T and 0.33 ± .479 units in Group E (P = 0.03). None required postoperative blood transfusion. Hb on day 5 was 9.74 ± 2.435 Gm in Group T and 10.62 ± 1.561 Gm in Group E (p = 0.1). No adverse effects were noted in both groups.
Conclusion: Tranexamic acid significantly reduces intra-operative blood loss and the requirement of blood transfusion during open femoral shaft surgeries, but the differences are not statistically significant in the postoperative period.
