Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty

Gillespie, Robert J.; Shishani, Yousef; Joseph, Sheeba M.; Streit, Jonathan J.; Gobezie, Reuben

doi:10.1016/j.jse.2015.07.029

Cited by 84 publications

(92 citation statements)

References 24 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%

“…Quality assessment of the RCTs was based on the Cochrane Collaboration tool (Table 3). All RCTs [15,16] provided clear inclusion and exclusion criteria and suggested a methodology of randomization, all of which described that randomization algorithm was generated from computer. One RCT [15] stated allocate concealment was achieved by sealed envelope.…”

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%

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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“…The oral form of TXA, marketed under the brand name Lysteda, was approved by the FDA in 2009 to control heavy menstrual bleeding [21]. The drug has also been widely studied for the reduction of bleeding in cardiopulmonary bypass (CPB) surgery [22][23][24][25][26][27][28][29], and orthopedic procedures [30] including its applicability in spine [31], knee [32], and shoulder surgery [33]. In the 1990's and early 2000's, the antiinflammatory properties of antifibrinolytics were recognized in patients undergoing CPB surgery, and in 2007 Jimenez et al published a manuscript confirming this observation [26].…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Update in Trauma

Ramirez

Spinella

Bochicchio

2017

Critical Care Clinics

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Following results from the CRASH-2 trial, tranexamic acid (TXA) gained considerable interest for the treatment of hemorrhage in trauma patients. Although TXA is effective at reducing mortality in patients presenting within 3 hours of injury, optimal dosing, timing of administration, mechanism, and pharmacokinetics require further elucidation. The concept of fibrinolysis shutdown in hemorrhagic trauma patients has prompted discussion of real-time viscoelastic testing and its potential role for appropriate patient selection. The results of ongoing clinical trials will help establish high-quality evidence for optimal incorporation of TXA in mature trauma networks in the United States and abroad.

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Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty

Cited by 84 publications

References 24 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

Tranexamic Acid Update in Trauma

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