Year 2017 Vol. 25 No 4




EE Vitebsk State Medical University,
The Republic of Belarus

Objectives. To evaluate the effectiveness of aminocaproic acid for reducing the perioperative blood loss in primary total knee joint replacement.
Methods. The patients (n=82) with the total knee joint replacement were included in the study. In the study group (n=42) parenteral administration of aminocaproic acid (100 mg/kg, 5% solution) was administered before applying the tourniquet, with repeated administration of the calculated dose of the drug in 4 hours. Patients of the control group (n=40) did not receive aminocaproic acid. The following indicators were compared: hemoglobin concentration, erythrocyte count, hematocrit volume of red blood cells prior to surgery and in the postoperative period (5 days). Drainage blood was recorded within 24 hours after the operation.
Results. In the study group blood loss/drainage volume was significantly reduced (300, 200-350 ml (Me 25%, 75%)) compared to the control group (600, 525-725 ml (Me, 25%, 75%)), p<0,001. In the postoperative period the drainage blood loss and calculated blood loss volumes were significantly higher for the control group (mean value of blood indicators in the study group: hemoglobin 118, 105 124 g/l, erythrocytes 3,95, 3,7 4,2×1012/l, hematocrit 36,55, 32,8 39,6 (Me 25%, 75%) and mean value of blood indicators: hemoglobin 105,5, 95 119 g/l, erythrocytes 3,45, 3,1 3,9×1012/ l, hematocrit 30, 95, 29,65 34,05 (Me, 25%, 75%)), p<0,05, respectively. In the control group, 11 patients (27,5%) were subjected to massive red blood cell transfusion. Donor blood component transfusion was not performed in the patients of the study group. No complication associated with aminocaproic acid application was registered.
Conclusion. The use of aminocaproic acid has proved to be an efficient and practical method of treatment patients with degenerative dystrophic diseases of the knee joint by eliminating the need for surgical blood transfusion in the total knee joint replacement, as well as by decreasing reimbursement for surgical procedures.

Keywords: knee joint replacement, blood loss, fibrinolysis inhibitors, aminocaproic acid, blood transfusion, economic costs, surgical intervention
p. 389-393 of the original issue
  1. Beletskii AV, Lomat' LN, Borisov AV, Mukhlia AM, Skakun PG, Vorobei EA. Sostoianie problemy i perspektivy razvitiia endoprotezirovaniia sustavov v Respublike Belarus' [The state of the problem and the development of arthroplasty prospects in the Republic of Belarus]. Zhurn GrGMU. 2010;(2):94-96
  2. Kurtz SM1, Ong KL, Lau E, Widmer M, Maravic M, Gómez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, Röder C. International survey of primary and revision total knee replacement. Int Orthop. 2011 Dec;35(12):1783-9. doi: 10.1007/s00264-011-1235-5. Epub 2011 Mar 15.
  3. Shah NA, Gupta A, Patel DV. Strategies do decrease blood loos in patients who undergo total knee replacement: a prospective study of one hundred and fifty cases. JISRF Reconstructive Review. 2013 Dec;3(4):18-26.
  4. Sehat KR1, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004 May;86(4):561-5.
  5. Bogomolov AN, Kanus II. Anesteziologicheskoe obespechenie i posleoperatsionnoe obezbolivanie pri total'nom endoprotezirovanii kolennogo sustava [Anesthesia and postoperative analgesia with total knee arthroplasty]. Novosti khirurgii. 2012;20(6):102-10.
  6. Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. Orthopedics. 2016 Mar-Apr;39(2):119-30. doi: 10.3928/01477447-20160301-05. Epub 2016 Mar 4.
  7. Borisov DB, Kirov MIu. Primenenie traneksamovoi kisloty pri endoprotezirovanii krupnykh sustavov [The use of tranexamic acid in endoprosthetics of large joints]. Novosti khirurgii. 2013;21(4):107-12.
  8. Lemaire R1. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br. 2008 Sep;90(9):1128-36. doi: 10.1302/0301-620X.90B9.21115.
  9. Lee QJ1, Mak WP, Yeung ST, Wong YC, Wai YL. Blood management protocol for total knee arthroplasty to reduce blood wastage and unnecessary transfusion. J Orthop Surg (Hong Kong). 2015 Apr;23(1):66-70.
  10. Henry DA1, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, Ker K. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001886. doi: 10.1002/14651858.CD001886.pub3.
  11. Kopanidis P1, Hardidge A2, McNicol L3,4, Tay S5, McCall P6, Weinberg L7,8,9 Perioperative blood management programme reduces the use of allogenic blood transfusion in patients undergoing total hip and knee arthroplasty. J Orthop Surg Res. 2016 Feb 29;11:28. doi: 10.1186/s13018-016-0358-1.
  12. Zufferey P1, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006 Nov;105(5):1034-46.
  13. Ortega-Andreu M, Pérez-Chrzanowska H, Figueredo R, Gómez-Barrena E. Blood loss control with two doses of tranexamic acid in a multimodal protocol for total knee arthroplasty. OpenOrthop J. 2011 Mar;16(5):44-8. doi: 10.2174/1874325001105010044.
  14. Churchill JL, Toney VA, Truchan S, Anderson MJ1. Using Aminocaproic Acid to Reduce Blood Loss After Primary Unilateral Total Knee Arthroplasty. Am J Orthop (Belle Mead NJ). 2016 Jul-Aug;45(5):E245-8.
  15. Shevchenko IuL, Stoiko IuM, Zamiatin NM, Teplykh BA, Karpov IA, Smol'kin DA. Krovosberegaiushchii effekt traneksamovoi kisloty pri protezirovanii kolennogo sustav [The cost-saving effect of tranexamic acid in prosthetic knee replacement ]. Obshchaia reanimatologiia. 2008;4(6):21-25.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze ave., 27,
Vitebsk State Medical University,
department of traumatology,
orthopedics and military field surgery, +375 29 654-45-99,
Konstantin B. Balaboshka
Information about the authors:
Balaboshka K.B. PhD, Ass.Professor, Head of department of traumatology, orthopedics and military field surgery, EE Vitebsk State Medical University.
Khadzkou Y.K. teacher trainee of department of traumatology, orthopedics and military field surgery, EE Vitebsk State Medical University.
Contacts | ©Vitebsk State Medical University, 2007-2023