Tranexamic acid in shoulder arthroplasty: A meta-analysis of randomized controlled trials

Tranexamic acid has been effectively used in a variety of joint arthroplasty procedures to minimize blood loss, leading to increased utilization in total shoulder arthroplasty. While several systematic reviews have been conducted exploring its efficacy, there has yet to be an up-to-date synthesis of all randomized trials on the topic, including a certainty of the evidence assessment.

We searched Embase, MEDLINE, and CENTRAL databases for peer-reviewed randomized trials comparing tranexamic vs. placebo in patients undergoing total shoulder arthroplasty. Screening, full-text review, and data extraction were performed independently and in duplicate by a team of reviewers. Outcomes of interest included blood loss, drainage output, transfusion rate, change in hemoglobin, pain and length of stay. We performed random-effects meta-analyses for each outcome, assessed risk of bias using the ROBUST-RCT tool, and conducted a certainty of the evidence assessment using the Grading of Recommendations Assessment, Development and Evaluation framework.

A total of six randomized trials, including 482 patients, were included in this systematic review and meta-analysis. Most studies utilized an intravenous tranexamic acid regimen involving 1 or 2g administered before surgery (n = 5); two studies administered a second dose at wound closure. Most studies (n = 4) recruited both standard and reverse total shoulder arthroplasty patients. Meta-analyses results of moderate-to-high certainty revealed significantly less blood loss (MD -240.05 mL [-319.43, -160.67]), drainage output at 24 h (-109.22 mL [-142.35, -76.08]) and 48 h (-105.15 mL [-194.33, -15.97]), and a lower change in hemoglobin (0.58 g/dL [0.32, 0.84]) with tranexamic acid compared to placebo. No significant differences in operative time, pain scores, transfusion rate, or length of stay were observed (p ≥ 0.05 for all).

The use of tranexamic acid in total shoulder arthroplasty can improve hematological outcomes post-operation without any effect on length of stay, operative time, or pain scores.