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Related Experiment Video

Updated: Nov 9, 2025

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

Richard L Donovan1, Jonny R Varma2, Michael R Whitehouse1,3

  • 1Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.

Journal of Orthopaedics
|April 15, 2021
PubMed
Summary
This summary is machine-generated.

Tranexamic acid (TXA) effectively reduces blood loss in total shoulder replacement (TSR). This antifibrinolytic agent is safe and associated with a shorter hospital stay, without increasing venous thromboembolic complications.

Keywords:
Arthroplasty, replacement, elbowArthroplasty, replacement, shoulderBlood loss, surgicalBlood transfusionMeta-analysisSystematic reviewTranexamic acidVenous thromboembolism

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Area of Science:

  • Orthopedic Surgery
  • Pharmacology

Background:

  • Tranexamic acid (TXA) is a well-established antifibrinolytic agent used to reduce blood loss in hip and knee replacements.
  • Its efficacy in total shoulder replacement (TSR) and total elbow replacement (TER) requires further investigation.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER).

Main Methods:

  • Systematic search of MEDLINE, EMBASE, and CENTRAL databases for randomized controlled trials (RCTs) and observational studies up to September 3, 2020.
  • Primary outcome: blood loss. Secondary outcomes: transfusion requirements and venous thromboembolic (VTE) complications.
  • Data synthesis using mean differences (MD) and relative risks with 95% confidence intervals (CIs).

Main Results:

  • Four RCTs and five retrospective cohort studies (RCS) were included for TSR; no studies met criteria for TER.
  • RCT data showed TXA significantly decreased estimated total blood loss (MD -358mL), post-operative blood loss (MD -113mL), and hemoglobin changes.
  • RCS data indicated TXA was associated with reduced post-operative blood loss, shorter hospital stays, and no significant increase in transfusion needs or VTE complications.

Conclusions:

  • TXA is safe and effective for primary TSR, significantly reducing blood loss and length of stay compared to placebo or no treatment.
  • No significant increase in VTE complications was observed with TXA use in TSR.
  • Routine consideration of TXA for TSR is recommended; further research is needed for TER.