Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis

Abstract

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.

Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities

“…It is possible that the decrease in postoperative blood transfusion observed in this study is related to the growing popularity of using tranexamic acid during TSA. Indeed, a meta-analysis by Kuo et al 25 showed a risk ratio of 0.34 (95% confidence interval: 0.14-0.79) for transfusion after TSA when tranexamic acid was used.…”

Trends in Inpatient Resource Utilization and Complications Among Total Joint Arthroplasty Recipients: A Retrospective Cohort Study

“…Improved perioperative care is likely contributing to these, such as better wound closure techniques, improved wound dressing, the utilization of tranexamic acid, and other blood preservation techniques. 29-31 As the LOS for all procedures also decreased, this raises the question whether the complication burden, particularly for those complications that present several days after joint arthroplasty, was merely shifted to intermediate care facilities such as skilled nursing facilities or acute rehab facilities to which joint arthroplasty patients were discharged. 20,25,28 In an era of intensified focus to shift joint arthroplasty to an outpatient setting, this issue deserves further study because it potentially represents an important patient safety issue.…”

Tranexamic Acid for Blood Loss after Transforaminal Posterior Lumbar Interbody Fusion Surgery: A Double-Blind, Placebo-Controlled, Randomized Study

“…Many methods have been developed to control bleeding during spinal surgery and mainly include minimal invasion procedures, patient positioning, deliberate hypotension, intraabdominal pressure control, infiltration of paraspinal tissues using vasoconstrictors, and pharmacological agents to enhance coagulation [10,[22][23][24][25]. TXA is known as an antifibrinolytic agent and acts through blocking the interaction of plasminogen and plasmin by competing with the lysine residues on the surface of fibrin to inhibit the fibrinolysis, resulting in clot stabilization [26][27][28][29]. Our study suggests that preoperative and intraoperative intravenous infusion of TXA can substantially reduce intraoperative blood loss and time to ambulation but shows no obvious impact on hospital stay after surgery, postoperative drainage, time for drainage removal, or postoperative Hb.…”