{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T23:55:35Z","timestamp":1774396535632,"version":"3.50.1"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) are antifibrinolytic agents commonly used to reduce blood loss in total knee arthroplasty (TKA). Although TXA is widely adopted, EACA offers a potentially more economical alternative. However, head-to-head comparisons using paired designs remain limited. The present randomized controlled trial included 294 patients undergoing bilateral TKA. Each patient received topical TXA in one knee and topical EACA in the contralateral knee in a randomized sequence. Primary outcomes included total perioperative blood loss and total drain output over 3 days. Secondary outcomes included transfusion requirement, postoperative complications, and cost-effectiveness. The statistical analyses included paired t-tests, linear mixed-effects models for effect modification, logistic regression for transfusion and complications, and cost-effectiveness analysis comparing drug costs against blood loss reduction. Data from 294 patients (588 knees) were analyzed. TXA was associated with a statistically significant but modest reduction in total blood loss compared with EACA (mean difference: 10.03\u2009mL, p\u2009&lt;\u20090.001), well below the predefined non-inferiority margin of 200\u2009mL. Similarly, drain output was also found to be lower in TXA-treated knees (mean difference: 10.07\u202fmL; p\u202f\u2009=\u2009\u202f0.0001), but the difference was not considered clinically significant. The rates of transfusion and postoperative complications were low (2.72 and 3.74% respectively). Cost-effectiveness analysis revealed EACA to be more cost effective as compared with TXA. Topical EACA was found to be non-inferior to TXA in reducing perioperative blood loss in TKA, with equivalent clinical outcomes and greater cost-effectiveness. These findings support the use of EACA as a cost-saving alternative to TXA, particularly in resource-limited settings.<\/jats:p>","DOI":"10.1055\/a-2741-1465","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:39:13Z","timestamp":1762994353000},"page":"273-282","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Topical Tranexamic Acid and Aminocaproic Acid for Reducing Blood Loss in Total Knee Arthroplasty: A Randomized Trial in Simultaneous Bilateral Total Knee Arthroplasty"],"prefix":"10.1055","volume":"39","clinical-trial-number":[{"clinical-trial-number":"ctri\/2020\/09\/027667","registry":"10.18810\/clinical-trial-registry-india"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5179-7641","authenticated-orcid":false,"given":"Nikhil","family":"Gupta","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8179-3027","authenticated-orcid":false,"given":"Kavin","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER) Satellite Centre, Sangrur, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asish Singh","family":"Passi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Anhad Clinic, Ludhiana, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nippun","family":"Prinja","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) Satellite Centre, Sangrur, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, AIMC Bassi Hospital, Ludhiana, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Max Super Specialty Hospital, Mohali, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"ref1","volume-title":"Total Knee Arthroplasty Techniques","author":"M A Varacallo","year":"2025"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"e508","DOI":"10.1016\/S2665-9913(23)00163-7","article-title":"Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"5","author":"J D Steinmetz","year":"2023","journal-title":"Lancet Rheumatol"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1016\/j.arth.2025.03.041","article-title":"Cost-volume analysis of primary total knee and hip arthroplasty in the United States","volume":"40","author":"G M Porter","year":"2025","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","article-title":"Are 20% of patients actually dissatisfied following total knee arthroplasty? 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Anaesth"},{"issue":"09","key":"ref36","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1302\/0301-620X.101B9.BJJ-2018-1096.R1","article-title":"Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? 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