Efficacy of aminocaproic acid in the control of bleeding after total knee and hip arthroplasty: A systematic review and meta-analysis

BACKGROUND: To assess the effectiveness and safety of intravenous aminocaproic acid for blood management after total knee and hip arthroplasty. METHODS: Electronic databases: PubMed (1950.1–2018.8), EMBASE (1974.1–2018.8), the Cochrane Central Register of Controlled Trials (CENTRAL, 2017.10), Web of Science (1950.1–2018.8), and CNKI (1980.1–2018.8) were systematically searched for clinical controlled trials comparing intravenous aminocaproic acid and placebo after joint arthroplasties. Heterogeneity was assessed using the chi-square test and I-square statistic. The meta-analysis was performed using STATA 12.0 (College Station, TX). RESULTS: Six studies with 756 patients were included. Our meta-analysis revealed that there were significant differences between aminocaproic acid and placebo in terms of total blood loss (SMD = −0.673, 95% CI: −0.825 to −0.520, P <.001), hemoglobin reduction (SMD = −0.689, 95% CI: −0.961 to −0.418, P <.001), drain output (SMD = −2.162, 95% CI: −2.678 to −1.646, P <.001) and transfusion rates (RD = −0.210, 95% CI: −0.280 to −0.141, P <.001). CONCLUSION: Aminocaproic acid results in a significant reduction of total blood loss, postoperative hemoglobin decline and transfusion requirement in patients undergoing arthroplasties. Due to the limited quality of the evidence currently available, the results of our meta-analysis should be treated with caution.