Effect of Tranexamic Acid on Hematologic Values and Blood Loss in Reverse Total Shoulder Arthroplasty

Abstract

.Purpose. Use of tranexamic acid (TXA) in the setting of arthroplasty of the lower extremity has been previously described. The aim of this study was to evaluate the benefit of a single dose of TXA (500 mg vial) administered intravenously just prior to RTSA in an Asian population. Methods. The records of 48 patients (no TXA, = 24, versus TXA, = 24) that underwent RTSA for cuff tear arthropathy were retrospectively reviewed. All patients had a Hemovac drain positioned for 2 days after surgery. Hemoglobin (Hb) and hematocrit (Hct) were checked on postoperative day 2 and compared with preoperative levels. Results. Hematologic change on postoperative day 2 as determined by Hb level after surgery was statistically lower in the TXA group (2.8 ± 0.8 versus 2.1 ± 0.8 (mg/dL), = 0.006). Mean fall in Hct level was also significantly less in the TXA group (8.0 ± 2.5 versus 6.1 ± 2.6 (L/L), = 0.012). Total Hemovac drainage tended to be lower in the TXA group (263.4 ± 129.3 versus 203.5 ± 84.2 (ml), = 0.064). TXA was found to have no noticeable side effects. Conclusion. The use of a single intravenous dose of TXA immediately prior to RTSA reduces hematologic deterioration postoperatively and the amount of Hemovac drainage. TXA could avoid unnecessary transfusion and its associated medical side effects and cost.

Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis

“…No additional studies were identified from the references of the included studies. After excluding 12 duplicates and 6 studies (two irrelevant topics and four systematic reviews), we finally included the following six studies in this meta-analysis: Abildgaard et al [ 33 ], Friedman et al [ 19 ], Gillespie et al [ 20 ], Kim et al [ 24 ], Pauzenberger et al [ 23 ], and Vara et al [ 34 ].

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“…The sample sizes ranged from 48 to 194, with a total 677 patients (680 shoulders, 343 in the TXA group and 337 in the non-TXA group). Three included studies [ 20 , 23 , 34 ] were RCTs that prospectively compared outcomes, and the other three RCS [ 19 , 24 , 33 ] compared results using retrospective analysis (Table 1 ). Further perioperative characteristics of the included studies are described in Table 2 .…”

“…2 Vara [ 34 ] 2017 Massive rotator cuff deficiency ± glenohumeral arthrosis RTSA 102 Randomized controlled trial TXA 53(20/33) Placebo 49(22/27) TXA: 67 ± 9 Placebo:66 ± 9 Blood loss via drainage, Hb change, ETBL, operation time, hospital stay, transfusions, complications Detail shown in Fig. 2 Abildgaard [ 33 ] 2016 TSA:1 ON and 7 OA RTSA:45 CTA, 34 massive cuff tear, 1 ON, 1RA, 11OA, and 2 fractures TSA 77 RTSA 94 Retrospective cohort study TXA 77 (49/28) Placebo 94 (51/43) TSA: TXA: 70 (53–87) Placebo:71 (58–87) RTSA TXA: 74 (54–90) Placebo: 76(54–89) Blood loss via drainage, Hb/Hct change, ETBL, transfusions, complications 9 a Friedman [ 19 ] 2016 Not mentioned TSA 97 RTSA 97 Retrospective cohort study TXA 106 (46/60) Placebo 88 (33/55) not mentioned Hb/Hct, recover room time, operation time, hospital stay, transfusions, complications 8 a Kim [ 24 ] 2017 CTA RTSA 48 Retrospective cohort study TXA 24 (3/21) Placebo 24 (6/18) TXA: 73.2 ± 4.4 Placebo: 74.2 ± 4.4 Hb/Hct change, operation time, blood loss via drainage 8 a CTA Cuff tear arthropathy; ETBL Estimated total blood loss; F Female; Hb Hemoglobin; Hct Hematocrit; M Male; OA Osteoarthritis; ON Osteonecrosis; RA Rheumatoid arthritis; RTSA Reverse total shoulder arthroplasty; TSA Total shoulder arthroplasty; TXA Tranexamic acid a Quality scores derived from the Newcastle-Ottawa Scale …”

“…2 . The three RCS [ 19 , 24 , 33 ] were of high quality (Newcastle-Ottawa Scale score > 7). For the risk of bias of the RCTs, random sequence generation and allocation concealment were not described in two trials [ 20 , 34 ], and therefore the risk of bias was rated as being unclear.…”

“…To date, few meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) has investigated the effects of TXA in TSA [ 21 , 22 ]. Even though more current studies on this issue have been published recently [ 23 , 24 ], systematic evaluations of the latest evidence on the use of TXA in shoulder arthroplasty, and especially in RTSA, are lacking. Therefore, to comprehensively examine the effects of TXA in shoulder arthroplasty, we conducted this systematic review and meta-analysis to evaluate outcomes including transfusion rate, total blood loss, changes in postoperative hemoglobin (Hb), operative time, hospital stay and thromboembolic events.…”