“…No additional studies were identified from the references of the included studies. After excluding 12 duplicates and 6 studies (two irrelevant topics and four systematic reviews), we finally included the following six studies in this meta-analysis: Abildgaard et al [ 33 ], Friedman et al [ 19 ], Gillespie et al [ 20 ], Kim et al [ 24 ], Pauzenberger et al [ 23 ], and Vara et al [ 34 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The sample sizes ranged from 48 to 194, with a total 677 patients (680 shoulders, 343 in the TXA group and 337 in the non-TXA group). Three included studies [ 20 , 23 , 34 ] were RCTs that prospectively compared outcomes, and the other three RCS [ 19 , 24 , 33 ] compared results using retrospective analysis (Table 1 ). Further perioperative characteristics of the included studies are described in Table 2 .…”
Section: Resultsmentioning
confidence: 99%
“…2 Vara [ 34 ] 2017 Massive rotator cuff deficiency ± glenohumeral arthrosis RTSA 102 Randomized controlled trial TXA 53(20/33) Placebo 49(22/27) TXA: 67 ± 9 Placebo:66 ± 9 Blood loss via drainage, Hb change, ETBL, operation time, hospital stay, transfusions, complications Detail shown in Fig. 2 Abildgaard [ 33 ] 2016 TSA:1 ON and 7 OA RTSA:45 CTA, 34 massive cuff tear, 1 ON, 1RA, 11OA, and 2 fractures TSA 77 RTSA 94 Retrospective cohort study TXA 77 (49/28) Placebo 94 (51/43) TSA: TXA: 70 (53–87) Placebo:71 (58–87) RTSA TXA: 74 (54–90) Placebo: 76(54–89) Blood loss via drainage, Hb/Hct change, ETBL, transfusions, complications 9 a Friedman [ 19 ] 2016 Not mentioned TSA 97 RTSA 97 Retrospective cohort study TXA 106 (46/60) Placebo 88 (33/55) not mentioned Hb/Hct, recover room time, operation time, hospital stay, transfusions, complications 8 a Kim [ 24 ] 2017 CTA RTSA 48 Retrospective cohort study TXA 24 (3/21) Placebo 24 (6/18) TXA: 73.2 ± 4.4 Placebo: 74.2 ± 4.4 Hb/Hct change, operation time, blood loss via drainage 8 a CTA Cuff tear arthropathy; ETBL Estimated total blood loss; F Female; Hb Hemoglobin; Hct Hematocrit; M Male; OA Osteoarthritis; ON Osteonecrosis; RA Rheumatoid arthritis; RTSA Reverse total shoulder arthroplasty; TSA Total shoulder arthroplasty; TXA Tranexamic acid a Quality scores derived from the Newcastle-Ottawa Scale …”
Section: Resultsmentioning
confidence: 99%
“…2 . The three RCS [ 19 , 24 , 33 ] were of high quality (Newcastle-Ottawa Scale score > 7). For the risk of bias of the RCTs, random sequence generation and allocation concealment were not described in two trials [ 20 , 34 ], and therefore the risk of bias was rated as being unclear.…”
Section: Resultsmentioning
confidence: 99%
“…Five included studies [ 19 , 20 , 23 , 33 , 34 ] reported the blood transfusion rate in the TXA and non-TXA groups. The risk of the need for a blood transfusion was lower in the TXA group compared to the non-TXA group (7/319 vs. 20/313, RR 0.34, 95% CI 0.14–0.79; P = 0.01; I 2 = 0%; Fig.…”
BackgroundThe effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events.ResultsWe identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to − 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to − 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to − 71.70), less change in hemoglobin (MD − 0.64 g/dl, 95% CI -0.86 to − 0.42), and less blood loss via drainage (MD − 84.56 ml, 95% CI -145.72.14 to − 23.39) than non-TXA group.ConclusionsThe use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA.Level of Evidence: Systematic Review and meta-analysis, III.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-1972-3) contains supplementary material, which is available to authorized users.
“…No additional studies were identified from the references of the included studies. After excluding 12 duplicates and 6 studies (two irrelevant topics and four systematic reviews), we finally included the following six studies in this meta-analysis: Abildgaard et al [ 33 ], Friedman et al [ 19 ], Gillespie et al [ 20 ], Kim et al [ 24 ], Pauzenberger et al [ 23 ], and Vara et al [ 34 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The sample sizes ranged from 48 to 194, with a total 677 patients (680 shoulders, 343 in the TXA group and 337 in the non-TXA group). Three included studies [ 20 , 23 , 34 ] were RCTs that prospectively compared outcomes, and the other three RCS [ 19 , 24 , 33 ] compared results using retrospective analysis (Table 1 ). Further perioperative characteristics of the included studies are described in Table 2 .…”
Section: Resultsmentioning
confidence: 99%
“…2 Vara [ 34 ] 2017 Massive rotator cuff deficiency ± glenohumeral arthrosis RTSA 102 Randomized controlled trial TXA 53(20/33) Placebo 49(22/27) TXA: 67 ± 9 Placebo:66 ± 9 Blood loss via drainage, Hb change, ETBL, operation time, hospital stay, transfusions, complications Detail shown in Fig. 2 Abildgaard [ 33 ] 2016 TSA:1 ON and 7 OA RTSA:45 CTA, 34 massive cuff tear, 1 ON, 1RA, 11OA, and 2 fractures TSA 77 RTSA 94 Retrospective cohort study TXA 77 (49/28) Placebo 94 (51/43) TSA: TXA: 70 (53–87) Placebo:71 (58–87) RTSA TXA: 74 (54–90) Placebo: 76(54–89) Blood loss via drainage, Hb/Hct change, ETBL, transfusions, complications 9 a Friedman [ 19 ] 2016 Not mentioned TSA 97 RTSA 97 Retrospective cohort study TXA 106 (46/60) Placebo 88 (33/55) not mentioned Hb/Hct, recover room time, operation time, hospital stay, transfusions, complications 8 a Kim [ 24 ] 2017 CTA RTSA 48 Retrospective cohort study TXA 24 (3/21) Placebo 24 (6/18) TXA: 73.2 ± 4.4 Placebo: 74.2 ± 4.4 Hb/Hct change, operation time, blood loss via drainage 8 a CTA Cuff tear arthropathy; ETBL Estimated total blood loss; F Female; Hb Hemoglobin; Hct Hematocrit; M Male; OA Osteoarthritis; ON Osteonecrosis; RA Rheumatoid arthritis; RTSA Reverse total shoulder arthroplasty; TSA Total shoulder arthroplasty; TXA Tranexamic acid a Quality scores derived from the Newcastle-Ottawa Scale …”
Section: Resultsmentioning
confidence: 99%
“…2 . The three RCS [ 19 , 24 , 33 ] were of high quality (Newcastle-Ottawa Scale score > 7). For the risk of bias of the RCTs, random sequence generation and allocation concealment were not described in two trials [ 20 , 34 ], and therefore the risk of bias was rated as being unclear.…”
Section: Resultsmentioning
confidence: 99%
“…Five included studies [ 19 , 20 , 23 , 33 , 34 ] reported the blood transfusion rate in the TXA and non-TXA groups. The risk of the need for a blood transfusion was lower in the TXA group compared to the non-TXA group (7/319 vs. 20/313, RR 0.34, 95% CI 0.14–0.79; P = 0.01; I 2 = 0%; Fig.…”
BackgroundThe effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events.ResultsWe identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to − 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to − 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to − 71.70), less change in hemoglobin (MD − 0.64 g/dl, 95% CI -0.86 to − 0.42), and less blood loss via drainage (MD − 84.56 ml, 95% CI -145.72.14 to − 23.39) than non-TXA group.ConclusionsThe use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA.Level of Evidence: Systematic Review and meta-analysis, III.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-1972-3) contains supplementary material, which is available to authorized users.
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.
Background: We evaluate tranexamic acid use in high-risk shoulder arthroplasty patients, hypothesizing that tranexamic acid will decrease transfusion rates in patients with low preoperative haematocrit. Methods: A retrospective review of shoulder arthroplasty patients with preoperative anaemia compared those treated with and without perioperative tranexamic acid. Inclusion criterion was any shoulder arthroplasty with a preoperative haematocrit (Hct) <38%. Tranexamic acid was given generally as 1 g intravenously before incision and 1 g during wound closure; topical tranexamic acid was used in cases of contraindication to IV tranexamic acid. Preoperative Hct, postoperative Hct, estimated blood loss, preoperative anticoagulation use, American Society of Anesthesiologist score, transfusion rate and demographic data were compared between groups with and without tranexamic acid. Results: Of the 435 arthroplasties performed, 109 patients had preoperative Hct < 38% (haemoglobin of 12.7 g/dL); 69 had tranexamic acid perioperatively and 40 did not. Demographics, anticoagulation use, diagnosis, arthroplasty types, estimated blood loss and preoperative Hct were similar between groups. The tranexamic acid group had a higher postoperative Hct, significantly lower transfusion rate and significantly smaller drop in Hct. Hct levels, Hct change and transfusion rate for topical versus intravenous tranexamic acid were not significantly different. Discussion: Perioperative tranexamic acid in high-risk shoulder arthroplasty patients with preoperative Hct <38% is associated with higher postoperative Hct and lower transfusion rates.
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