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, 張磊, 汪國友, 等. 反式全肩關節置換術的治療研究進展. 中華肩肘外科電子雜志, 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.	東靖明. 反置式人工肩關節置換術并發癥. 中華肩肘外科電子雜志, 2019(3): 287.
4.	中國康復技術轉化及發展促進會, 中國研究型醫院學會關節外科學專業委員會, 中國醫療保健國際交流促進會關節疾病防治分會, 等. 中國骨科手術加速康復圍手術期氨甲環酸與抗凝血藥應用的專家共識. 中華骨與關節外科雜志, 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.	國家衛生健康委員會公益性行業科研專項《關節置換術安全性與效果評價》項目組, 中國老年保健醫學研究會老年骨與關節病分會專家組. 中國人工肩關節置換術加速康復圍手術期管理策略專家共識. 中華肩肘外科電子雜志, 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, 張磊, 汪國友, 等. 反式全肩關節置換術的治療研究進展. 中華肩肘外科電子雜志, 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. 東靖明. 反置式人工肩關節置換術并發癥. 中華肩肘外科電子雜志, 2019(3): 287.
4. 中國康復技術轉化及發展促進會, 中國研究型醫院學會關節外科學專業委員會, 中國醫療保健國際交流促進會關節疾病防治分會, 等. 中國骨科手術加速康復圍手術期氨甲環酸與抗凝血藥應用的專家共識. 中華骨與關節外科雜志, 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. 國家衛生健康委員會公益性行業科研專項《關節置換術安全性與效果評價》項目組, 中國老年保健醫學研究會老年骨與關節病分會專家組. 中國人工肩關節置換術加速康復圍手術期管理策略專家共識. 中華肩肘外科電子雜志, 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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