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Award-winning study: TXA reduced blood loss after total shoulder arthroplasty
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Results of this randomized, double-blind study showed patients who had tranexamic acid applied at the end of either total shoulder or reverse total shoulder arthroplasty had less blood loss and more preserved hemoglobin levels than patients who received placebo.
Researchers of this study, which received the Neer Award, prospectively evaluated 111 patients who underwent either total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). A control group 55 patients were randomized to receive 100 mL of normal saline, and 56 patients received 100 mL normal saline and 2 g of tranexamic acid (TXA). Both solutions were topically applied on the wound at the end of arthroplasty. All patients had postoperative drains.
Results showed the TXA group had significantly lower postoperative blood loss compared with the control group (110 mL vs. 170 mL). Postoperative blood loss was not significantly different between patients who underwent TSA or RTSA. There was a significantly smaller drop in hemoglobin levels from preoperative values in patients who received TXA vs. those who received the placebo. None of the patients had perioperative complications, according to researchers. ‒ by Monica Jaramillo
Disclosures: Gillespie reports he is a consultant for DJO Medical. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopJay D. Keener, MD
This prospective randomized trial examined the effectiveness of topical tranexamic acid in reducing blood loss after primary shoulder arthroplasty. The endpoints included measurement of 24-hour surgical drain output and postoperative decrease in hemoglobin levels in 111 patients. Patients with pre-existing anemia were excluded.
Although the number of recruited patients was less than initially proposed, the authors noted significantly less drain output and drop in postoperative hemoglobin levels in the patients who received tranexamic acid (TXA). No patients from either group required postoperative blood transfusion. Subgroup analysis showed TXA to be more effective in decreasing drain output following anatomic total shoulder arthroplasty while the reduction in postoperative hemoglobin levels was significant only following reverse shoulder arthroplasty.
These findings help to establish the safety of topical TXA in shoulder arthroplasty surgery and suggest a possible role for selective use of TXA in higher transfusion-risk patients. However, the modest reduction in blood loss associated with TXA use combined with the lower need for blood transfusions after shoulder arthroplasty compared to hip and knee arthroplasty limit the generalizability of the current study findings. Further research is needed to define the role of TXA use in higher risk patients where the potential benefits of TXA can be maximized.
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