Tranexamic acid administration for anatomic and reverse total shoulder arthroplasty: a systematic review and meta-analysis

Abstract

Background: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss and risk of blood transfusion. Evidence establishing its efficacy in total shoulder arthroplasty (TSA) is limited. The current study evaluated the effect of TXA on perioperative blood loss and transfusion risk after TSA.

Methods: A systematic review and meta-analysis of TXA administration for TSA was performed, and 6 studies with a total of 680 patients were found. Data on change in hemoglobin, drain output, total blood loss, and transfusion were extracted. Meta-analysis was performed with stratification into reverse and anatomic TSA subgroups.

Results: TXA administration was associated with decreased change in hemoglobin (-0.63 g/dL; 95% CI, -0.87 to -0.39 g/dL; P < .00001), drain output (-112.05 mL; 95% CI, -182.29 to -41.81 mL; P < .0001), and total blood loss (-231.87 mL; 95% CI, -334.23 to -129.48 mL; P < .00001) after reverse TSA. There was a trend toward reduction in transfusion rate after reverse TSA (-4%; 95% CI, -8% to 0%; P = .06). TXA administration was associated with reduced drain output after anatomic TSA (-123.07 mL; 95% CI, -163.93 to -82.20 mL; P < 0.00001). TXA administration was not associated with decreased transfusion rate after anatomic TSA. Data to evaluate the effect of TXA on change in hemoglobin and total blood loss after anatomic TSA were insufficient.

Conclusions: Routine administration of TXA reduces perioperative blood loss and may reduce the risk of transfusion after reverse TSA. Future studies are needed to further characterize its effect on the risk of transfusion after reverse TSA and efficacy in anatomic TSA.

Keywords: Anatomic total shoulder arthroplasty; Meta-analysis; Reverse total shoulder arthroplasty; Total blood loss; Tranexamic acid; Transfusion.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2

Forest plots of change in hemoglobin for combined (above) and reverse total shoulder arthroplasty (below). The squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The horizontal lines represent the 95% confidence interval (CI). The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated 95% CIs. The vertical line indicates no effect. TXA, tranexamic acid; SD, standard deviation; IV, inverse variance.

Figure 3

Forest plots of drain output for combined (top), reverse total shoulder arthroplasty (middle), and anatomic total shoulder arthroplasty (bottom). The squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The horizontal lines represent the 95% confidence interval (CI). The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated 95% CIs. The vertical line indicates no effect. TXA, tranexamic acid; SD, standard deviation; IV, inverse variance.

Figure 4

Forest plots of total blood loss for combined (above) and reverse total shoulder arthroplasty (below). The squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The horizontal lines represent the 95% confidence interval (CI). The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated 95% CIs. The vertical line indicates no effect. TXA, tranexamic acid; SD, standard deviation; IV, inverse variance.

Figure 5

Forest plots of risk of transfusion for combined (top), reverse total shoulder arthroplasty (middle), and anatomic total shoulder arthroplasty (bottom). The squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The horizontal lines represent the 95% confidence interval (CI). The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated 95% CIs. The vertical line indicates no effect. TXA, tranexamic acid; SD, standard deviation; IV, inverse variance.