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Tranexamic Acid Reduces Bleeding and Early Pain but Does Not Improve Intraoperative Visualization in Arthroscopic
Xiali Xue1,2, Xinguo Zhuang3, Xuchang Zhou3
1School of Sports Medicine and Health Science, Chengdu Sport University, Chengdu, China.
Purpose:
To evaluate the effects of tranexamic acid (TXA) on postoperative blood loss, operation time, pain control, and complications in arthroscopic rotator cuff repair and to investigate its impact on intraoperative visualization clarity, hemoglobin, and mean arterial pressure.
Methods:
Randomized controlled trials up to February 2025 were comprehensively searched in databases such as PubMed, Embase, and the Cochrane Library. Literature was screened according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The quality of included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis of postoperative blood loss, operation time, Visual Analog Scale for pain, and complication rates was conducted using RevMan 5.4 software.
Results:
A total of 9 randomized controlled trials (691 patients) were included. The results showed that compared with the control group, the TXA group significantly reduced surgical blood loss (mean difference = -6.40 mL, 95% confidence interval (CI): -12.44 to -0.36, P = .04, I2 = 62%), shortened operation time (mean difference = -8.60 min, 95% CI: -12.83 to -4.37, P < .00001, I2 = 59%), and decreased Visual Analog Scale pain scores at 24 hours postoperatively (mean difference = -0.65, 95% CI: -0.97 to -0.34, P < .0001, I2 = 41%), but the minimal clinically important difference was not reached. There was no statistically significant difference at both 24 and 48 hours. TXA lowered the overall complication rate (odds ratio = 0.23, 95% CI: 0.08 to 0.69, P = .009, I2 = 0). However, TXA did not have a significant effect on intraoperative visualization clarity, postoperative hemoglobin levels, or mean arterial pressure.
Conclusions:
TXA reduces postoperative bleeding, shortens operation time, alleviates early pain (within 24 hours), where no significant differences were observed at 48 or 72 hours postoperatively, and lowers the incidence of complications in arthroscopic rotator cuff repair, with a favorable safety profile.
Level Of Evidence:
Level III, systematic review of Level I and III studies.
