Tranexamic acid use is associated with lower transfusion rates in shoulder arthroplasty patients with preoperative anaemia

Abstract

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.

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

“…A recent retrospective study evaluated the efficacy of TXA in SA patients with preoperative anemia. 41 These authors found that the transfusion rate in this group of patients was 25% and TXA was associated with a reduction of 80% in transfusion rates. If the main aim with perioperative use of TXA is decreasing transfusions, it is possible that TXA in SA is a cost-effective intervention only in selected subgroups of patients.…”

The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty

“…32,33 Our reported transfusion rate of 2.1% was lower than much of the reported TSA literature, which ranges from 3.9% to 25%. [34][35][36] This may owe to the increasing rates of successful tranexamic acid use in shoulder arthroplasty over the years, 37,38 as well as differing institutional protocols and potentially improved preoperative assessments.…”

Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials

“… 3 , 4 , 10 , 43 , 52 , 60 , 61 , 64 Several studies have reported using TXA in shoulder arthroplasty. 1 , 6 , 7 , 11 , 12 , 13 , 17 , 18 , 23 , 29 , 31 , 33 , 44 , 53 , 59 , 65 , 66 However, the existing studies have limitations, such as small sample size, low-quality studies, and different TXA administration.…”