Abstract: OBJECTIVE: Tranexamic acid and epsilon-aminocaproic acid have been extensively utilized for hemostasis in orthopedic surgery; however, comparative studies focusing on the hemostatic efficacy of the two drugs in total joint arthroplasty remain relatively scarce. The present article was conducted to systematically assess the effectiveness and safety of two drugs in total hip arthroplasty and total knee arthroplasty. 
METHODS: Published studies on the perioperative application of tranexamic acid and epsilon-aminocaproic acid in total knee arthroplasty or total hip arthroplasty were identified from the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP, and SinoMed from inception until November 1, 2024. After removing duplicate references, two researchers conducted literature screening and data extraction based on predefined inclusion and exclusion criteria. Statistical analysis of total blood loss, transfusion rate, incidence of deep venous thrombosis, and other relevant indicators was performed using Review Manager 5.3 software. 
RESULTS: This meta-analysis finally included 7 randomized controlled trials and 5 non-randomized controlled trials involving 4 101 patients. During total hip arthroplasty and total knee arthroplasty, compared with epsilon-aminocaproic acid, tranexamic acid could significantly reduce total blood loss (MD=−109.58, 95%CI: −169.08 to −50.07, P < 0.001), postoperative drainage volume (MD=−35.66, 95%CI: −64.99 to −6.33, P=0.02), and hemoglobin loss (MD=−0.25, 95%CI: −0.40 to −0.09, P=0.002), and the differences were significant. However, there were no significant differences in intraoperative blood loss, operation time, hospital stay, transfusion rate, blood transfusion unit per patient, and deep vein thrombosis incidence between the two groups (P > 0.05). 
CONCLUSION: Meta-analysis results show that compared with epsilon-aminocaproic acid, tranexamic acid can effectively reduce the perioperative total blood loss, postoperative drainage volume, and hemoglobin loss of patients, but it does not show obvious advantages in terms of blood transfusion rate, hospital stay, and deep vein thrombosis incidence. Tranexamic acid has better hemostatic effect during joint arthroplasty. Therefore, tranexamic acid is still recommended as the first choice hemostatic drug during total hip and total knee arthroplasties.  

Key words: joint arthroplasty, total knee arthroplasty, total hip arthroplasty, tranexamic acid, epsilon-aminocaproic acid, meta-analysis