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Review
. 2021 Mar 18:24:239-247.
doi: 10.1016/j.jor.2021.03.003. eCollection 2021 Mar-Apr.

Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: A systematic review and meta-analysis

Richard L Donovan  1 , Jonny R Varma  2 , Michael R Whitehouse  1   3 , Ashley W Blom  1   3 , Setor K Kunutsor  1   3
Affiliations
Review

Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: A systematic review and meta-analysis

Richard L Donovan et al. J Orthop. .

Abstract

Purpose: Tranexamic acid (TXA) is an inexpensive antifibrinolytic agent that significantly reduces peri-operative blood loss and transfusion requirements after total hip and knee replacement. This meta-analysis demonstrates the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER).

Methods: We systematically searched MEDLINE, EMBASE and CENTRAL from inception to September 03, 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss. Secondary outcomes included the need for blood transfusion, and post-operative venous thromboembolic (VTE) complications. Mean differences (MD) and relative risks with 95% confidence intervals (CIs) were reported.

Results: Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss (MD -358mL), post-operative blood loss (MD -113mL), change in haemoglobin (Hb) (MD -0.71 g/dL) and total Hb loss (MD -35.3g) when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in post-operative blood loss, change in Hb, change in Hct and length of stay. There was no significant difference in transfusion requirements or VTE complications.

Conclusion: TXA administration in safe and effective in patients undergoing primary TSR: it significantly decreases blood loss compared with placebo and is associated with shorter length of stay compared with no treatment. No significant increase in VTE complications was found. TXA administration should be routinely considered for patients undergoing TSR. Further research is needed to demonstrate the treatment effect in patients undergoing TER.

Keywords: Arthroplasty, replacement, elbow; Arthroplasty, replacement, shoulder; Blood loss, surgical; Blood transfusion; Meta-analysis; Systematic review; Tranexamic acid; Venous thromboembolism.

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Conflict of interest statement

AWB and MRW disclose financial activities, all outside the submitted work. All authors have completed uniform disclosure forms.

Figures

Fig. 1
Fig. 1
PRISMA flow chart.
Fig. 2
Fig. 2
Forest plot for estimated total blood loss (top = RCT data only; bottom = RCS data only).
Fig. 3
Fig. 3
Forest plot for drain output (post-operative blood loss) (top = RCT data only; bottom = RCS data only).
Fig. 4
Fig. 4
Forest plot for change in Hb (top = RCT data only; bottom = RCS data only).
Fig. 5
Fig. 5
Forest plot for transfusion rates (top = RCT data only; bottom = RCS data only).
None
None
See this image and copyright information in PMC

References

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