A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial

Abstract

Background: Hematoma formation and the need for blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. Materials and methods: We conducted a double-blind randomized controlled trial comparing intravenous TXA vs. placebo in 60 patients undergoing primary anatomic or reverse shoulder arthroplasty. Of these patients, 29 received a placebo whereas 31 received a single dose of 2 g of intravenous TXA. Patient demographic characteristics, as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay, and pain score, were recorded. Patients were followed up for 12 weeks to assess for complications. Results: Patients who received TXA had a lower drain tube output at all time points: 41 mL vs. 133 mL at 6 hours, 75 mL vs. 179 mL at 12 hours, and 94 mL vs. 226 mL at 24 hours (P < .001 for all). They also had a higher postoperative hemoglobin (Hb) level (12.3 g/dL vs. 11.4 g/dL, P ¼ .009), lower change in Hb level (1.7 g/dL vs. 2.3 g/dL, P ¼ .011), lower total Hb loss (0.078 g vs. 0.103 g, P ¼ .042), lower blood volume loss (0.55 L vs. 0.74 L, P ¼ .021), higher postoperative hematocrit level (36.7% vs. 34.6%, P ¼ .020), and lower hematocrit change (5.4% vs. 7.6%, P ¼ .022). There was no significant difference in pain score or length of hospital stay, and no patients required a transfusion. Conclusion: A single dose of 2 g of intravenous TXA decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. No differences were detected in the occurrence of complications, need for transfusion, pain score, or length of hospital stay. With the mounting evidence now available, patients undergoing elective primary shoulder arthroplasty should be given intravenous TXA to decrease perioperative blood loss.

Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials

“…The literature primary search yielded 72 articles，and no additional studies were obtained. After removing duplicates, screening title and abstracts, five RCTs 12,13,18,44,59 met the inclusion criteria, and a total of 435 patients (Table Ⅰ) were included in this study (216 in the Non-TXA group and 219 in the TXA group).…”

“…33,53 Blood loss and transfusions are common complications for shoulder arthroplasty. 12 Several studies have reported that the blood transfusion rates after TSA range from 4% to 43%. 2,5,21,22,26,39,40,45,48,51 In addition, blood transfusion may cause allergic reactions, transmission of viruses, allergic reactions, infection, and cardiovascular dysfunction.…”

“…2,10,52,60,64 Several studies have reported using TXA in shoulder arthroplasty. 1,6,8,11,12,13,17,18,23,30,31,33,44,53,59,65,66 However, the existing studies have limitations, such as small samples, low quality studies, and different TXA administration.…”

“…As a new RCT study reported a single dose of tranexamic acid in shoulder arthroplasty, a meta-analysis needs to performed. 12 This systematic review and meta-analysis aimed to evaluate extant Level I randomized controlled trials (RCTs) examining the efficacy of TXA in primary shoulder arthroplasty.…”

“…One study was a J o u r n a l P r e -p r o o f multicenter trials 18 , and 4 studies were single-center trial. 12,13,44,59 Mean BMI Four studies reported mean body mass index (BMI). Vara et al reported a mean BMI of 29.2±6.7 kg/m for the TXA group and 30.7±8.3 kg/m 2 for the non-TXA group.…”