Topical and Intravenous Tranexamic Acid Are Equivalent in Decreasing Blood Loss in Total Shoulder Arthroplasty

Budge, Matthew D.

doi:10.1177/2471549218821181

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…Of these 14 studies that used an IV approach, 10 reported favorable outcomes for postoperative hematologic parameters. The most commonly reported changes were a reduction in blood volume loss, reduction in hemoglobin or hematocrit change, and decreased drain output 15–24 . Only 1 study, conducted by Kissin et al 25 , reported a negative finding in regard to blood volume loss with administration of IV TXA.…”

Section: Resultsmentioning

confidence: 99%

Tranexamic Acid in Total Shoulder Arthroplasty

Laungani,

Porto,

Haase

et al. 2024

JBJS Reviews

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Background: The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable practice variability concerning the optimal route of administration and dosing protocols concerning the medication's use. Our aim was to conduct a scoping review of the literature regarding the efficacy of various methods of TXA administration in TSA and to identify knowledge gaps that may be addressed. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The PubMed and MEDLINE electronic databases were searched to identify all articles published before March 2023 investigating the administration of TXA in TSA. Randomized controlled trials and cohort studies were included, and data were extracted to capture information regarding intervention details and related outcomes such as blood loss, transfusion needs, and complication rates. Results: A total of 15 studies were included in this review. All selected studies used either intravenous (IV) or topical TXA, with 1 study also including a combined approach of both topical and IV TXA. Of the studies that used an IV approach, the most commonly reported favorable outcomes were a reduction in blood volume loss, reduction in hemoglobin or hematocrit change, and decreased drain output. Dosing varied significantly between all identified studies because some used a standard dosing amount in grams or milligrams for all treatment group participants, whereas others used weight-based dosing amounts. All studies that used a weight-based dosing regimen as well as studies using a standard dosing amount between 1,000 and 5,000 mg reported favorable outcomes for postoperative blood loss. Conclusion: Both IV and topical TXA clearly demonstrate favorable perioperative hematologic profiles in TSA. Although both approaches have demonstrated a successful association with decreased blood loss and transfusion requirements, there is no definitive benefit to choosing one over the other. Furthermore, the use of oral TXA either in combination or isolation warrants further study in TSA because of its comparable efficacy profiles and significantly lower associated costs of application.

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Section: Resultsmentioning

confidence: 99%

Tranexamic Acid in Total Shoulder Arthroplasty

Laungani,

Porto,

Haase

et al. 2024

JBJS Reviews

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“…To the best of our knowledge, there have not been many studies comparing these two methods of TXA application. Budge et al in 2019 conducted a retrospective review on a group of only three patients comparing whether Intravenous and topical TXA are equivalent in improving postoperative hemoglobin in TSA [ 33 ]. However, Li et al, in a meta-analysis, evaluated the efficiency and safety of combined use of intravenous and topical versus single intravenous TXA [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

Pecold

Al-Jeabory

Krupowies³

et al. 2021

JCM

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Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

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“…Transfusion requirements were reported in all nine TSR studies [33][34][35][36][37][38][39][40]. RCT data showed a decrease in the number of blood transfusions in the TXA group compared with the placebo group (RR = 0.50; 95% CI: 0.16, 1.54; p = 0.919; Figure 5 top), but this was not significant.…”

Section: Transfusion Requirementsmentioning

confidence: 96%

“…Fifteen papers failed to meet the eligibility criteria. Therefore, nine studies were deemed eligible for inclusion in this systematic review and meta-analysis [33][34][35][36][37][38][39][40][41]. A PRISMA flow chart is provided in Figure 1.…”

Section: 1study Selectionmentioning

confidence: 99%

1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

Varma

Donovan

Whitehouse

et al. 2021

British Journal of Surgery

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Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

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Topical and Intravenous Tranexamic Acid Are Equivalent in Decreasing Blood Loss in Total Shoulder Arthroplasty

Cited by 6 publications

References 35 publications

Tranexamic Acid in Total Shoulder Arthroplasty

Tranexamic Acid in Total Shoulder Arthroplasty

Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

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