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

Abstract

Background: The effects of tranexamic acid (TXA) in total shoulder arthroplasty (TSA) are controversial. The objective of this study was to investigate the efficacy and safety of TXA in TSA. Methods: A systematic review and meta-analysis of TXA in TSA was carried out, and 5 trials including 372 patients were identified from PubMed (1966 to March 2024), Cochrane Central Register of Controlled Trials (March 2024), Embase (1974 to March 2024) and Web of Science (1995 to March 2024). Only randomized controlled trials (RCTs) were enrolled. Review Manager (RevMan, version 5.4, the Cochrane Collaboration, 2020) was used for statistical analysis. Primary outcomes were blood loss volume and allogenic blood transfusion rate. Secondary outcomes were drain out, postoperative change in hemoglobin (Hb), hospital stay, operation time, visual analogue score (VAS) pain score and complications. Results: This study found significant reduction in blood loss volume (MD = -269.06 ml; 95% CI = -367.25 to -170.87, P < 0.01), drain out (MD = -106.99 ml; 95% CI = -138.24 to -75.75, P < 0.001) at postoperative 1d, and postoperative change in hemoglobin (Hb) (MD = -0.40 g/dl; 95% CI = -0.94 to -0.14, P < 0.001) at postoperative 1d with the use of TXA. No significant differences in blood transfusion rate, hospital stay, operation time and complication rate between TXA and control groups. Conclusions: The use of TXA in TSA reduces blood loss significantly. Further researches with large sample size are needed to investigate the effect and safety of TXA for shoulder arthroplasty in the revision TSA.