Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis

“…Five of six cases of frozen shoulder occurred in the control group and one in the TXA group; one of three patients with re-tears underwent reverse shoulder arthroplasty, as reported by Mackenzie et al [ 14 ]. Functional outcomes were assessed by Mackenzie et al [ 14 ], and there was no difference between groups in [ 2 , 8 , 24 ], and 52 weeks in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form or Constant score.…”

“…TXA is commonly used in upper and lower limb arthroplasty to limit blood loss and postoperative hematoma formation [ 6 , 7 ]. Tranexamic acid has been evaluated for its usefulness in reducing blood volume loss, drain output, and hematocrit changes after shoulder arthroplasty [ 8 ]. Additionally, TXA has been shown to decrease blood loss, drain output, and hemarthrosis, and improve pain scores and range of motion in the initial postoperative period, without increased complications or thromboembolic events after anterior cruciate ligament reconstruction and the open Latarjet procedure [ 9 , 10 ].…”

Systematic review and meta-analysis of intravenous and topical tranexamic acid in reducing blood loss in knee arthroplasty

“…The current meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement [23] and the rec-ommendations of Cochrane Collaboration. The study is a continuation of the authors' research on the effectiveness and safety of TXA in orthopedics [24].…”

Effectiveness and safety of tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis

“…In the light of current research, its use is important in reducing intraoperative bleeding and the need for blood transfusion in the postoperative period in patients undergoing total knee arthroplasty [2]. The use of tranexamic acid in the perioperative period does not increase the risk of adverse thromboembolic complications [1,3]. In selected groups of patients, the use of TXA without the use of a tourniquet gives comparable results in terms of reducing the risk of bleeding during surgery as the use of only a tourniquet [4].…”