Antifibrinolytic drugs such as tranexamic acid (TXA) and aminocaproic acid (EACA) have been proved could effectively reduce perioperative blood loss in total knee arthroplasty (TKA). The aim of this study is to compare hemostatic effect and drug safety of TXA and EACA in TKA.

A total of 196 patients who underwent unilateral TKA at Xi'an Honghui Hospital were retrospectively analyzed from August 2023 to February 2024. Among them, there were 50 males and 146 females, with an average age of 66.5±7.5 years. According to the different usage of antifibrinolytic drugs, patients were divided into the TXA group (n=98) and the EACA group (n=98). The administration method of drug was intravenous transfusion combined with intra-articular injection. There was no drainage tube placed for each patient after surgery. Hemostatic efficacy of these two drugs were compared by contrasting perioperative blood loss, transfusion rate, and decline of hemoglobin between two groups of patients. Drug safety was also compared by analyzing complications such as wound bleeding, deep vein thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI). Knee Society Score (KSS), flexion range of knee and visual analog scale (VAS) of two groups were analyzed to compare knee joint function.

A total of 196 patients was followed up for 3 months after surgery. The mean decline of hemoglobin in TXA group was 20.0(12.0, 32.5) g/L, no significant deffierence compared with 25.0(16.8, 34.5)g/L of EACA group (P=0.072). In terms of perioperative blood loss, TXA group was also significantly lower than the EACA group (746.9±490.7 and 918.6±371.4 ml, P=0.012). Perioperative transfusion rate of TXA group was 1. 0%, no significant difference compared to 3.1% in EACA group (P=0.313). The incidence of periprosthetic infection (PJI) and deep vein thrombosis (DVT) in each group of patients was 1.0%. No pulmonary embolism were found in each group during follow-up period. The VAS score of TXA group was 2.0(0.0, 2.0) at last follow-up, which was significantly higher than 2.0(0.0, 2.0) EACA group (P=0.005). There was no significant difference in knee flexion range between TXA group (107.9±12.3)° and EACA group (109.6±11.9)° (P=0.262). The KSS of TXA group was 78.4±15.6 at last follow-up. There was no significant difference compared to 77.9±15.9 of EACA group (P=0.807).

It was found in this study that hemostatic effect of TXA was significantly better than EACA in primary TKA. TXA group had less amount of blood loss and lower transfusion rate. The incidence of complications between these two groups were relatively approximated. Thus, TXA was recommended as preferred anti fibrinolytic drug in perioperative period of TKA.