Intraoperative tranexamic acid use in total shoulder arthroplasty: a meta-analysis_West China Medical Journal

Authors：

 LIU Kai , WANG Yongcai , HUANG Qiu , WANG Hongchuan

Department of Orthopedics, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Total shoulder arthroplasty; Reverse shoulder arthroplasty; Tranexamic acid; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.202103259

Video：

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Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.

Citation： LIU Kai, WANG Yongcai, HUANG Qiu, WANG Hongchuan. Intraoperative tranexamic acid use in total shoulder arthroplasty: a meta-analysis. West China Medical Journal, 2021, 36(10): 1366-1371. doi: 10.7507/1002-0179.202103259 Copy

1.	覃波, 张磊, 汪国友, 等. 反式全肩关节置换术的治疗研究进展. 中华肩肘外科电子杂志, 2019, 7(2): 97-100.
2.	Zumstein MA, Pinedo M, Old J, et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg, 2011, 20(1): 146-157.
3.	东靖明. 反置式人工肩关节置换术并发症. 中华肩肘外科电子杂志, 2019(3): 287.
4.	中国康复技术转化及发展促进会, 中国研究型医院学会关节外科学专业委员会, 中国医疗保健国际交流促进会关节疾病防治分会, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
5.	Gillespie R, Shishani Y, Joseph S, et al. Neer Award 2015: a randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty. J Shoulder Elbow Surg, 2015, 24(11): 1679-1684.
6.	Vara AD, Koueiter DM, Pinkas DE, et al. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial. J Shoulder Elbow Surg, 2017, 26(8): 1383-1389.
7.	Pauzenberger L, Domej MA, Heuberer PR, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty. Bone Joint J, 2017, 99(8): 1073-1079.
8.	Cvetanovich GL, Fillingham YA, O’Brien M, et al. Tranexamic acid reduces blood loss after primary shoulder arthroplasty: a double-blind, placebo-controlled, prospective, randomized controlled trial. JSES Open Access, 2018, 2(1): 23-27.
9.	Cunningham G, Hughes J, Borner B, et al. A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg, 2021, 30(7): 1553-1560.
10.	Kim SH, Wise BL, Zhang Y, et al. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am, 2011, 93(24): 2249-2254.
11.	国家卫生健康委员会公益性行业科研专项《关节置换术安全性与效果评价》项目组, 中国老年保健医学研究会老年骨与关节病分会专家组. 中国人工肩关节置换术加速康复围手术期管理策略专家共识. 中华肩肘外科电子杂志, 2021, 9(2): 97-102.
12.	Anthony SG, Patterson DC, Cagle PJ Jr, et al. Utilization and real-world effectiveness of tranexamic use in shoulder arthroplasty: a population-based study. J Am Acad Orthop Surg, 2019, 27(19): 736-742.
13.	Kuo LT, Hsu WH, Chi CC, et al. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2018, 19(1): 60.
14.	Yoon JY, Park JH, Kim YS, et al. Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study. J Shoulder Elbow Surg, 2020, 29(6): 1087-1095.
15.	Tobian AA, Heddle NM, Wiegmann TL, et al. Red blood cell transfusion: 2016 clinical practice guidelines from AABB. Transfusion, 2016, 56(10): 2627-2630.
16.	Kim MS, Kim JD, Ro KH, et al. Hematologic profile in reverse total shoulder arthroplasty: perioperative and postoperative blood loss. J Shoulder Elbow Surg, 2019, 28(9): 1737-1742.
17.	Dacombe PJ, Kendall JV, McCann P, et al. Blood transfusion rates following shoulder arthroplasty in a high volume UK centre and analysis of risk factors associated with transfusion. Shoulder Elbow, 2019, 11(2Suppl): 67-72.
18.	Kandil A, Griffin JW, Novicoff WM, et al. Blood transfusion after total shoulder arthroplasty: which patients are at high risk?. Int J Shoulder Surg, 2016, 10(2): 72-77.
19.	Shin YS, Yoon JR, Lee HN, et al. Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3585-3595.
20.	Wei Z, Liu M. The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2 720 cases. Transfus Med, 2015, 25(3): 151-162.

1. 覃波, 张磊, 汪国友, 等. 反式全肩关节置换术的治疗研究进展. 中华肩肘外科电子杂志, 2019, 7(2): 97-100.
2. Zumstein MA, Pinedo M, Old J, et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg, 2011, 20(1): 146-157.
3. 东靖明. 反置式人工肩关节置换术并发症. 中华肩肘外科电子杂志, 2019(3): 287.
4. 中国康复技术转化及发展促进会, 中国研究型医院学会关节外科学专业委员会, 中国医疗保健国际交流促进会关节疾病防治分会, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
5. Gillespie R, Shishani Y, Joseph S, et al. Neer Award 2015: a randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty. J Shoulder Elbow Surg, 2015, 24(11): 1679-1684.
6. Vara AD, Koueiter DM, Pinkas DE, et al. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial. J Shoulder Elbow Surg, 2017, 26(8): 1383-1389.
7. Pauzenberger L, Domej MA, Heuberer PR, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty. Bone Joint J, 2017, 99(8): 1073-1079.
8. Cvetanovich GL, Fillingham YA, O’Brien M, et al. Tranexamic acid reduces blood loss after primary shoulder arthroplasty: a double-blind, placebo-controlled, prospective, randomized controlled trial. JSES Open Access, 2018, 2(1): 23-27.
9. Cunningham G, Hughes J, Borner B, et al. A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg, 2021, 30(7): 1553-1560.
10. Kim SH, Wise BL, Zhang Y, et al. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am, 2011, 93(24): 2249-2254.
11. 国家卫生健康委员会公益性行业科研专项《关节置换术安全性与效果评价》项目组, 中国老年保健医学研究会老年骨与关节病分会专家组. 中国人工肩关节置换术加速康复围手术期管理策略专家共识. 中华肩肘外科电子杂志, 2021, 9(2): 97-102.
12. Anthony SG, Patterson DC, Cagle PJ Jr, et al. Utilization and real-world effectiveness of tranexamic use in shoulder arthroplasty: a population-based study. J Am Acad Orthop Surg, 2019, 27(19): 736-742.
13. Kuo LT, Hsu WH, Chi CC, et al. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2018, 19(1): 60.
14. Yoon JY, Park JH, Kim YS, et al. Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study. J Shoulder Elbow Surg, 2020, 29(6): 1087-1095.
15. Tobian AA, Heddle NM, Wiegmann TL, et al. Red blood cell transfusion: 2016 clinical practice guidelines from AABB. Transfusion, 2016, 56(10): 2627-2630.
16. Kim MS, Kim JD, Ro KH, et al. Hematologic profile in reverse total shoulder arthroplasty: perioperative and postoperative blood loss. J Shoulder Elbow Surg, 2019, 28(9): 1737-1742.
17. Dacombe PJ, Kendall JV, McCann P, et al. Blood transfusion rates following shoulder arthroplasty in a high volume UK centre and analysis of risk factors associated with transfusion. Shoulder Elbow, 2019, 11(2Suppl): 67-72.
18. Kandil A, Griffin JW, Novicoff WM, et al. Blood transfusion after total shoulder arthroplasty: which patients are at high risk?. Int J Shoulder Surg, 2016, 10(2): 72-77.
19. Shin YS, Yoon JR, Lee HN, et al. Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3585-3595.
20. Wei Z, Liu M. The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2 720 cases. Transfus Med, 2015, 25(3): 151-162.

West China Medical Journal

Intraoperative tranexamic acid use in total shoulder arthroplasty: a meta-analysis

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