Abstract
BackgroundThe effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events.ResultsWe identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to − 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to − 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to − 71.70), less change in hemoglobin (MD − 0.64 g/dl, 95% CI -0.86 to − 0.42), and less blood loss via drainage (MD − 84.56 ml, 95% CI -145.72.14 to − 23.39) than non-TXA group.ConclusionsThe use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA.Level of Evidence: Systematic Review and meta-analysis, III.
Highlights
The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear
reverse total shoulder arthroplasty (RTSA) has been reported to be an independent predictor of the need for a blood transfusion after shoulder arthroplasty [2], which implied that patients undergoing RTSA bled more than total shoulder arthroplasty (TSA)
Our study shows that TXA reduces blood loss and the need for blood transfusion, suggesting that it could be applied to patients undergoing RTSA
Summary
The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Shoulder arthroplasty, including both TSA and RTSA, is associated with a considerable risk of perioperative blood loss, and a reported allogeneic blood transfusion rate ranging from 4.3% to 43% [1,2,3,4,5,6,7]. A previous study of a healthcare database reported that patients who received a perioperative blood transfusion had a higher risk of medical complications including myocardial infarction, pneumonia, sepsis, and cerebrovascular accidents, as well as venous thromboembolic events and surgical complications including periprosthetic infections, periprosthetic fractures, and mechanical complications [11]. It is not likely the transfusion itself that causes these complications
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