Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis
Abstract Background The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and...
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-018-1972-3 |
| _version_ | 1818439841344389120 |
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| author | Liang-Tseng Kuo Wei-Hsiu Hsu Ching-Chi Chi Jae Chul Yoo |
| author_facet | Liang-Tseng Kuo Wei-Hsiu Hsu Ching-Chi Chi Jae Chul Yoo |
| author_sort | Liang-Tseng Kuo |
| collection | DOAJ |
| description | Abstract Background The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events. Results We identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to − 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to − 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to − 71.70), less change in hemoglobin (MD − 0.64 g/dl, 95% CI -0.86 to − 0.42), and less blood loss via drainage (MD − 84.56 ml, 95% CI -145.72.14 to − 23.39) than non-TXA group. Conclusions The use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA. Level of Evidence: Systematic Review and meta-analysis, III. |
| first_indexed | 2024-12-14T18:02:52Z |
| format | Article |
| id | doaj.art-fbe439a3614d4d539d3d6166d7bd934c |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-14T18:02:52Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-fbe439a3614d4d539d3d6166d7bd934c2022-12-21T22:52:26ZengBMCBMC Musculoskeletal Disorders1471-24742018-02-0119111310.1186/s12891-018-1972-3Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysisLiang-Tseng Kuo0Wei-Hsiu Hsu1Ching-Chi Chi2Jae Chul Yoo3Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial HospitalDivision of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial HospitalCentre for Evidence-Based Medicine, Chang Gung Memorial HospitalDepartment of Orthopedic Surgery, College of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineAbstract Background The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events. Results We identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to − 0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to − 159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to − 71.70), less change in hemoglobin (MD − 0.64 g/dl, 95% CI -0.86 to − 0.42), and less blood loss via drainage (MD − 84.56 ml, 95% CI -145.72.14 to − 23.39) than non-TXA group. Conclusions The use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA. Level of Evidence: Systematic Review and meta-analysis, III.http://link.springer.com/article/10.1186/s12891-018-1972-3Total shoulder arthroplastyReverse total shoulder arthroplastyTranexamic acidBlood lossTransfusion |
| spellingShingle | Liang-Tseng Kuo Wei-Hsiu Hsu Ching-Chi Chi Jae Chul Yoo Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis BMC Musculoskeletal Disorders Total shoulder arthroplasty Reverse total shoulder arthroplasty Tranexamic acid Blood loss Transfusion |
| title | Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis |
| title_full | Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis |
| title_fullStr | Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis |
| title_full_unstemmed | Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis |
| title_short | Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis |
| title_sort | tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty a systematic review and meta analysis |
| topic | Total shoulder arthroplasty Reverse total shoulder arthroplasty Tranexamic acid Blood loss Transfusion |
| url | http://link.springer.com/article/10.1186/s12891-018-1972-3 |
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