Tranexamic Acid in the Latarjet Procedure – A Randomized Controlled Trial

Abstract

The aim of the present study was to assess whether tranexamic acid (TXA) could reduce the incidence of postoperative swelling and hematoma formation, pain and opioid use following the Latarjet procedure. TXA is commonly used in orthopaedic surgery to reduce peri-operative bleeding and the need for transfusion. Recently, TXA has been used in shoulder arthroplasty, where it has been shown to reduce blood loss and postoperative pain levels through reduced swelling and hematoma formation. A randomized controlled trial was conducted in 100 patients undergoing open Latarjet surgery for anterior shoulder instability. Patients were randomized to receive either 1g TXA intravenously prior to skin incision or a placebo. Outcomes measured were 1) intra-operative blood loss, 2) post-operative blood loss (via drain output), 3) postoperative soft tissue swelling or hematoma formation, 4) Visual Analogue Scale for pain (VAS score), and 5) postoperative opioid use (in morphine mg equivalents). A p-value of < 0.05 was considered to be statistically significant. There was no significant difference in baseline patient demographics or characteristics in terms of age (23.8±3.4 vs 25.1±6.5 years), gender (f/m: 2/48 vs 2/48), body mass index (24.8±2.9 vs 26.5±3.9), and surgical time (43±7 vs 45±8 minutes) between the two groups. There was no significant difference in intra-operative blood loss (61.8mls vs 68.5mls, p = 0.18). However, there was significantly lower post-operative blood loss in the TXA group (29.8mls vs 65.5mls, p < 0.01). There was a significantly lower rate of painful postoperative swelling and hematoma formation (4% vs 30%, p < 0.01). No postoperative hematoma requiring further management was reported during the study period. Additionally, we found a significantly lower VAS score for pain (1.8 vs 3.0, p < 0.01), significantly less postoperative opioid use (9mg vs 21.4mg, p <0.01) and a significantly lower rate of patients requiring opioid analgesia during the postoperative period (36% vs 67%, p < 0.01) in the TXA group. The current study found that TXA significantly decreased postoperative blood loss, painful soft tissue swelling and hematoma formation, and subsequently reduced post-operative pain and opioid use following the Latarjet procedure.