The effect of epsilon aminocaproic acid on blood loss in patients who undergo primary total hip replacement: a pilot study.

OBJECTIVE To determine if the use of an antifibrinolytic agent (epsilon aminocaproic acid [EACA]) decreased perioperative and postoperative blood loss in patients who underwent total hip arthroplasty (THA). DESIGN A prospective, double-blind, randomized, controlled clinical trial. SETTING A university-affiliated tertiary care hospital with a large joint arthroplasty population. PARTICIPANTS Fifty-five patients who were scheduled for a primary THA. METHOD Patients were randomly assigned to 2 groups to receive either EACA or saline placebo perioperatively. Preoperatively, the groups were similar with respect to gender, mean age, mean hemoglobin level, operative time and prosthesis type. OUTCOME MEASURES Blood loss from the start of surgery until the Hemovac drain was removed, and the transfusion rate and hemoglobin levels. RESULTS Mean (and standard error) total blood loss for patients receiving EACA was 867 (207) mL and for patients receiving placebo was 1198 (544) mL (p < 0.025). Four patients in the EACA group received 7 units of packed red blood cells and 7 patients in the saline group required 12 units. CONCLUSIONS Patients receiving the placebo sustained greater total blood loss than EACA patients and were more likely to require blood transfusion. In the current climate of concern over blood transfusions during surgery, EACA administration can reduce blood loss and consequently transfusion and transfusion-related risk.