Tranexamic acid in shoulder surgery: a narrative review

Tranexamic acid (TXA) has become a popular perioperative adjunct in orthopedic surgery for its ability to reduce total blood loss, transfusion rates, and associated complications. Although most data are within total hip and knee arthroplasty along with other open procedures, TXA in shoulder surgery remains less certain. Shoulder surgery encompasses a broad spectrum of techniques from minimally invasive arthroscopy to a variety of open approaches that each have distinct soft tissue planes, operative exposures, and opportunities for bleeding. Each procedure carries its own bleeding profiles, perioperative considerations, and outcomes of interest, and data for TXA indications vary accordingly. In open shoulder surgery, TXA is used to minimize intraoperative and post-operative blood loss, while in arthroscopic surgery, it helps limit bleeding for better visualization. This narrative review seeks to evaluate the current evidence of TXA use in shoulder surgery and provide a practical resource for surgeons and perioperative teams involved in management.