The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Abstract

Background:The purpose of this meta-analysis is to compare the efficacy of tranexamic acid (TXA) versus placebo after a total shoulder arthroplasty (TSA).Methods:In April 2017, a systematic computer-based search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, and Google. Studies comparing TXA versus placebo in reducing blood loss after TSA were included. The endpoints were the need for transfusion, blood loss in drainage, hemoglobin drop, and total blood loss. Stata 12.0 software was used for the meta-analysis.Results:Six studies involving a total of 637 patients met the inclusion criteria. The meta-analysis revealed that, compared with control groups, treatment with TXA could decrease the need for transfusion (P < .00001), blood loss in drainage (P = .000), hemoglobin drop (P = .001), and total blood loss (P = .000).Conclusion:TXA can decrease the need for transfusion as well as total blood loss in TSA patients. There was a negative correlation between the TXA dose and the need for transfusion and blood loss in drainage. Because the administration route and the dose of TXA were different, more studies are needed in order to identify the optimal dose and route.

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

“…No adverse events were recorded, which is consistent with the recently published meta-analyses of TXA use in shoulder arthroplasty that found no adverse events across all studies. 4,21,28,43,49 This finding is also consistent with results from hip and knee arthroplasty. 14,16,25,36,50 TXA use in shoulder arthroplasty has received significant recent interest.…”

Inconclusive evidence for the efficacy of tranexamic acid in reducing transfusions, postoperative infection or hematoma formation after primary shoulder arthroplasty: A meta-analysis with trial sequential analysis

“…Three meta-analyses 14,16,18 reported significant reduction of blood transfusions after SA with TXA, whereas other three 13,15,17 did not find significant differences on transfusions after SA between TXA and placebo (Table 4). Possible reasons for these contradictory results include the inclusion of retrospective non-randomized studies, the use of different pooling methodologies to produce a combined estimate (i.e.…”

“…The question of whether TXA is effective in decreasing blood loss in SA is already resolved. [13][14][15][16][17][18] However, whether TXA remains as a cost-effective intervention even if it has no or minimal effect on transfusion rates, the best dose and route of administration of TXA in SA and the effect of TXA on subpopulations of SA patients with differential risks are still unanswered questions. There is a need for large multicenter pragmatic RCTs to examine the effectiveness of TXA on clinically relevant outcomes in a heterogeneous group of patients undergoing SA, including patients with a higher baseline risk of transfusion (e.g.…”

“…10 Previous studies and meta-analyses of the use of TXA in total hip arthroplasty (THA) and total knee arthroplasty (TKA) have shown that TXA is a safe and cost-effective perioperative method of reducing blood loss and transfusion requirements during or after the procedure. 11,12 The current evidence from several metaanalyses of the efficacy of TXA in SA [13][14][15][16][17][18] demonstrate that TXA is effective in decreasing blood loss as measured by drain output, change in hemoglobin (Hb) or total calculated blood loss. However, the results of the efficacy of TXA on clinically relevant adverse outcomes such as transfusions or postoperative infection in SA have been contradictory.…”

The use of intra-operative tranexamic acid in shoulder surgery: Protocol for a systematic review and meta-analysis

“…Recent systematic reviews have demonstrated TXA to be effective in reducing blood loss and transfusion rates in lower limb arthroplasty and spinal surgery [10] , [11] , [12] . Most recently, clinical trials investigating its use in shoulder arthroplasty have shown favourable results [13] , [14] , [15] , [16] , [17] , [18] . The overall clinical effectiveness of tranexamic acid use in shoulder surgery is of interest.…”