Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study

Yoon, Ji Young; Park, Joo Hyun; Kim, Yang Soo; Shin, Sang Jin; Yoo, Jae Chul; Oh, Joo Han

doi:10.1016/j.jse.2020.02.013

Cited by 18 publications

(22 citation statements)

References 60 publications

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“…Only RCTs were included. Of these, 3 were conducted in the United States, 5,12,37 1 in Ireland, 19 1 in Austria, 31 1 in China, 11 1 in South Korea, 40 and 1 in Taiwan. 25 Sample sizes ranged from 54 to 111, with 708 patients (406 received TXA, 302 received placebo).…”

Section: Resultsmentioning

confidence: 99%

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Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis

2021

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Background: Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery. Purpose: To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non–bleeding-related outcomes. Study Design: Systematic review and meta-analysis. Methods: A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate. Results: Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, −209.66 mL; 95% CI, −389.11 to −30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, −84.8 mL; 95% CI, −140.04 to −29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, –0.33 g/dL; 95% CI −0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures. Conclusion: This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required. Clinical Relevance: TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.

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Section: Resultsmentioning

confidence: 99%

“…One study 40 in the systematic review was an RCT comparing the method of administration of TXA in patients undergoing RTSA. This study found no significant difference in postoperative blood loss, hemoglobin reduction, or total blood loss when comparing topical, IV, or combined administration routes.…”

Section: Resultsmentioning

confidence: 99%

Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis

2021

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“…Intravenous TXA administration has shown similar results. 48 Vara et al 45 reported in their prospective randomized trial that patients given 2 doses of intravenous TXA of 10 mg/kg (1 dose given 60 minutes before surgery and 1 dose given at wound closure) had significantly less blood loss, total Hb loss, and drain tube output compared with patients given a placebo. A transfusion was required postoperatively in 14.3% of the patients in the placebo group and 5.7% in the TXA group.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have seemed to show similar results in shoulder arthroplasty. 48 According to another meta-analysis concerning lowerlimb arthroplasty, combined administration of TXA is associated with significantly reduced total blood loss, postoperative Hb decline, drainage volume, and transfusion requirements in comparison with a single application. 35 The role and safety of TXA in patients at high risk of thromboembolic events are still to be established.…”

Section: Discussionmentioning

confidence: 99%

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

Cunningham

Hughes²,

Borner

et al. 2021

Journal of Shoulder and Elbow Surgery

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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.

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“…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.…”

Section: Level Of Evidence: Level ⅰ Systematic Review and Meta-analysismentioning

confidence: 99%

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

Fan

Zhang

2021

JSES Reviews, Reports, and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study

Cited by 18 publications

References 60 publications

Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis

Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis

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

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

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