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Intravenous versus oral tranexamic acid in shoulder arthroplasty
Tarishi Parmar1,2, Akin Adio3, Mohammad Daher4
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA. txp539@students.jefferson.edu.
Purpose:
Tranexamic acid (TXA) is used in shoulder arthroplasty to reduce blood loss. While intravenous (IV) TXA is standard, oral TXA offers advantages in cost and administration. This study compares 90-day complications and postoperative laboratory values between IV and oral TXA in total shoulder arthroplasty (TSA).
Methods:
A retrospective cohort study using TriNetX identified adults undergoing primary TSA (2005-2025) receiving TXA on the day of surgery, stratified by route (IV vs. oral). One-to-one propensity score matching was performed. Ninety-day outcomes included transfusion, thromboembolic events, cardiac and renal complications, neurologic events, infection, wound dehiscence, readmissions, emergency department visits, opioid utilization, and mortality. Postoperative laboratory outcomes included hemoglobin, erythrocyte count, hematocrit, and platelet count. Outcomes were compared using odds ratios (ORs) with 95% confidence intervals (CIs) and t tests where appropriate.
Results:
After matching, 5722 patients were included in each cohort. No significant differences were observed between IV and oral TXA in 90-day transfusion rates (P = 0.873) or thromboembolic events, including deep vein thrombosis and pulmonary embolism. Rates of myocardial infarction, stroke, cardiac ischemia, acute renal failure, infection, readmission, emergency department visits, opioid use, and mortality were also comparable between groups (all P > 0.05). Postoperative laboratory values, including hemoglobin, erythrocyte count, hematocrit, and platelet count, did not differ significantly between IV and oral TXA cohorts (all P > 0.14).
Conclusion:
In this large propensity-matched analysis, oral TXA demonstrated equivalent safety, complication rates, and postoperative laboratory profiles compared with IV TXA following TSA. These findings support oral TXA as a clinically effective alternative to IV administration, offering potential advantages in cost reduction and resource utilization without compromising patient safety. Future prospective studies should evaluate optimal dosing strategies, patient-specific selection criteria, and formal cost-effectiveness analyses to further define the role of oral TXA in shoulder arthroplasty pathways.
Level Of Evidence:
III, Retrospective Cohort Study.
