Tranexamic acid linked with reduced blood loss across all types of shoulder surgery
Tranexamic acid was associated with reduced perioperative bleeding in all types of shoulder surgeries and may reduce postoperative pain and operation time, according to published results.
To assess the efficacy of tranexamic acid (TXA) for reducing blood loss during shoulder surgery, researchers from the University of Oxford performed a systematic review of eight randomized controlled trials found in the MEDLINE, Embase, PsycINFO and Cochrane Library databases. All types of open and arthroscopic shoulder procedures were included in the review: total shoulder arthroplasty, reverse TSA, open Latarjet and arthroscopic rotator cuff repair.
The researchers compared TXA with placebo treatment and assessed each respective procedure for total blood loss, postoperative blood loss (measured by drain output at 24 hours) and reduction in hemoglobin.
According to the study, total blood loss was recorded in four trials. The pooled mean difference was –209.66 mL, which indicated a “significant reduction when using TXA,” the researchers wrote in the study. Similarly, four trials recorded postoperative blood loss. Again, the researchers observed a “significant reduction” in postoperative blood loss, indicated by a pooled mean difference of –84.8 mL.
In addition, five studies compared hemoglobin levels in patients who received TXA or placebo. With similar results, the researchers deemed no statistical significance between the two interventions.
Overall, the researchers found TXA was effective for reducing blood loss after shoulder surgery.
“The results of this study complement the current literature regarding the use of TXA in shoulder surgery. It highlights the efficacy of TXA in reducing blood loss,” they wrote. “The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time,” they added.
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The recent systematic review and meta-analysis by Alexander Hartland, MD, and co-authors further emphasizes the benefits of tranexamic acid (TXA) use in shoulder surgery, which has now become routine in shoulder arthroplasty procedures. The findings are consistent with the prior meta-analysis by Kirsch and colleagues (Tranexamic acid in shoulder arthroplasty: A systematic review and meta-analysis, JBJS Reviews 2017) that demonstrated decreased blood loss (drain output and change in hemoglobin) in patients receiving TXA as compared to controls.
The strengths of the current systematic review by Hartland and colleagues are the inclusion of recent randomized controlled trials (2015-2020) in the analysis, as well as studies from non-English languages. The study is weakened, however, by the small numbers of non-arthroplasty (two arthroscopy and one open Latarjet procedures) compared with the five shoulder arthroplasty studies included. While the study supports the use of TXA in reducing blood loss in shoulder arthroplasty, these conclusions cannot be applied to all patients having shoulder surgery. As the authors acknowledge in the discussion, “increased numbers of RCTs investigating the use of TXA in arthroscopy are required to review this topic separately.” Despite this limitation however, this is an important review that provides further support that TXA is effective in reducing blood loss in shoulder arthroplasty. Based on these findings, the routine administration of TXA in all shoulder arthroplasty (anatomic and reverse shoulder replacement) procedures should be encouraged.
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