Concentration, Antibacterial Effect, and Safety of Combining Intra-articular Epsilon-Aminocaproic Acid and Vancomycin in Primary Total Knee Arthroplasty: A Randomized Study.

In 30 seconds

This randomized study examined intra-articular vancomycin with or without epsilon-aminocaproic acid (EACA) in patients undergoing unilateral primary total knee arthroplasty; a propensity score-matched EACA-only group was also included. Perioperative blood loss with the combination was equivalent to EACA alone and significantly lower than with vancomycin alone (P < 0.01). The combination produced higher intra-articular vancomycin levels at eight and 24 hours than vancomycin alone, with similar serum levels, but did not improve antibacterial effects over vancomycin alone. No acute renal injury, ototoxicity, or anaphylaxis was observed.

Key findings

• Perioperative blood loss with vancomycin plus EACA was equivalent to EACA alone and significantly lower than with vancomycin alone (P < 0.01).
• Intra-articular vancomycin levels were higher with the combination than with vancomycin alone at eight and 24 hours; serum levels were similar.
• Antimicrobial effects were comparable with vancomycin plus EACA and vancomycin alone, and both exceeded EACA alone.
• No acute renal injury, ototoxicity, or anaphylaxis occurred.

Why it matters

The findings address whether combining an antifibrinolytic with intra-articular vancomycin in primary knee arthroplasty compromises either drug’s measured effects. The combination maintained EACA’s blood-loss effect and increased local vancomycin concentrations, but did not provide greater antibacterial activity than vancomycin alone. These results help frame the potential benefits and limits of this combined approach.

What to keep in mind

The EACA-only comparison group was propensity score-matched rather than randomized.