More Data Supporting Tranexamic Acid, Now for Shoulder Surgeries

Using tranexamic acid during any type of shoulder surgery can effectively reduce perioperative bleeding, a new study finds.

In the study, “Clinical Effectiveness of Intraoperative Tranexamic Acid Use in Shoulder Surgery: A Systematic Review and Meta-analysis,” published online on January 21, 2021 in The American Journal of Sports Medicine, researchers measured the effectiveness of tranexamic acid on bleeding and non-bleeding related outcomes in all types of shoulder surgeries. They included both open and arthroscopic procedures.

“Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery,” the study authors wrote.

The systematic review and meta-analysis included all randomized controlled trials evaluating the use of tranexamic acid against placebo in all types of shoulder surgery. The primary outcome was total blood loss.

Overall, eight randomized controlled trials were included in the systematic review. Data from seven of the studies were pooled in the meta-analysis.

Pooled analysis showed a significant reduction in two of three outcomes measuring perioperative bleeding with tranexamic acid compared with controls.

Estimated total blood loss was mean difference, -209.66 mL; 95% CI, -389.11 to -30.21; p = .02). Postoperative blood loss as measured by drain output was mean difference, -84.8 mL; 95% CI, -140.04 to -29.56; p = .003). Hemoglobin reduction was reduced but not by a statistically significant amount.

“This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required,” the authors wrote.

“TXA can be used across shoulder surgery to reduce perioperative blood loss. The use of tranexamic acid may have other beneficial features, including reduced postoperative pain and reduced operative time.”