Tranexamic acid decreases blood loss after total shoulder arthroplasty

Friedman, Richard J.; Gordon, Eric; Butler, R. Bryan; Mock, Lisa; Dumas, Bonnie P.

doi:10.1016/j.jse.2015.09.014

Cited by 56 publications

(84 citation statements)

References 36 publications

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“…Finally, 4 studies meet eligibility criteria of the present meta-analysis—2 of them were RCTs [15,16] and 2 were non-RCTs. [17,18] Overall, the 4 studies included 250 patients in the tranexamic acid group and 234 patients in the control group.…”

Section: Resultsmentioning

confidence: 99%

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Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Sun

Zhang

et al. 2017

Medicine

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Objective:This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty.Methods:A systematic search was performed in Embase (1980–2017.04, embase.com), Medline (1966–2017.04, medline.com), PubMed (1966–2017.04, pubmed.com), ScienceDirect (1985–2017.04, sciencedirect.com), and Web of Science (1950–2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software.Results:In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] −172.16, 95% confidence interval [CI] −35.46 to −308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI −0.12 to 0.22, P = .89, d = 0.19), length of stay (MD −0.06, 95% CI −0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53).Conclusion:Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required.

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Section: Resultsmentioning

confidence: 99%

“…[15–17] A random-effects model was used ( χ 2 = 12.78, df = 2, I 2 = 84.3%, P = .002). No significant difference in the length of hospital stay was observed between the 2 groups (MD −0.06, 95% CI −0.26 to 0.14, P = .56, d = 0.20; Fig.…”

Section: Resultsmentioning

confidence: 99%

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Sun

Zhang

et al. 2017

Medicine

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“…In these situations, it is recommended either to decolonize the patient before the surgery or to give a one-time dose of vancomycin [12]. In addition to antibiotics, pre-incision intravenous administration of tranexamic acid has been shown in multiple studies to decrease intraoperative blood loss [13,14]. At this point, skin incision is ready to be made.…”

Section: Positioning and Drapingmentioning

confidence: 99%

Surgical Approaches in Shoulder Arthroplasty

Sager¹,

Khazzam²

2018

Advances in Shoulder Surgery

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Shoulder arthroplasty is a complex procedure that is becoming increasingly more utilized throughout the world. Due to the numerous static and dynamic stabilizers of the glenohumeral joint, along with the relative proximity to vital neurovascular structures, great care must be taken to access the joint in a safe and effective manner. To date, there are two well-described approaches utilized in shoulder arthroplasty: the deltopectoral approach and the anterosuperior approach. Both of these approaches are effective in accessing the glenohumeral joint; however, due to their anatomic location, they both have distinct advantages and disadvantages. The aim of this book chapter is to describe the methodology for approaching the glenohumeral joint through each of these approaches, as well as to discuss the advantages and disadvantages of utilizing each. In addition, we aim to discuss the various methodologies for closing these wounds and, briefly, to discuss the other approaches described in the orthopedic literature.

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“…(TXA), a synthetic analogue of the amino acid lysine, can competitively inhibit the activation of plasminogen by binding to specific sites on both plasminogen and plasmin, thus inhibiting the degradation of fibrin and breakdown of blood clots. Several studies suggest that TXA reduces blood loss in joint arthroplasty without increasing risk of thromboembolic complications . TXA is also widely accepted as effective for reducing blood loss and transfusion requirement in primary THA, but its safety and optimal administration route are controversial …”

Section: Introductionmentioning

confidence: 99%

“…Several studies suggest that TXA reduces blood loss in joint arthroplasty without increasing risk of thromboembolic complications. [12][13][14] TXA is also widely accepted as effective for reducing blood loss and transfusion requirement in primary THA, but its safety and optimal administration route are controversial. 15 TXA can be administered intravenously, topically, orally or by a combination of these routes.…”

Section: Introductionmentioning

confidence: 99%

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Xie¹,

Zhang

Chen³

et al. 2019

Brit J Clinical Pharma

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Aim This study aimed to compare the efficacy and safety of different tranexamic acid (TXA) routes following primary total hip arthroplasty (THA). Methods We collected data from the National Health Database on patients registered from January 2013 to September 2017. The patients were divided based on TXA administration route into a control group (without TXA), intravenous group, topical group and combined group. The primary outcome was transfusion; secondary outcomes were total blood loss, haemoglobin level, decrease in haemoglobin on postoperative day 3, and incidence of complications. Results Data were collected on 7667 primary THA, 4662 with TXA and 3005 without TXA. The transfusion rate was 28.7% in the control group, 12.7% in the topical group, 8.9% in the intravenous group, and 6.1% in the combined group, and the inter‐group differences were significant (P < .01). The combined group showed significantly smaller total blood loss (1.23 ± 0.52 L), smaller reduction in haemoglobin level (26.5 ± 11.1 g/L) and higher haemoglobin level on postoperative day 3 (107.0 ± 15.5 g/L) than the other three groups (P < .05). The three TXA groups showed significantly lower incidence of deep vein thrombosis than the control group (0.08% vs 0.47%, P = .001) as well as a lower rate of other complications (0.34% vs 0.67%, P = .044). Conclusion TXA is effective and safe to decrease blood loss and transfusion following primary THA, regardless of whether it is administered intravenously, topically or both. Intravenous or combined routes may produce better haemostatic effects, so they may be suggested in the absence of contraindications.

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Tranexamic acid decreases blood loss after total shoulder arthroplasty

Cited by 56 publications

References 36 publications

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Surgical Approaches in Shoulder Arthroplasty

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

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