Tranexamic Acid Effective in Reducing Blood Loss in Shoulder Surgery

Takeaway

• This meta-analysis suggests that tranexamic acid (TXA) is effective in reducing perioperative blood loss in shoulder surgery.
• The use of TXA may also reduce post-operative pain.

Why this matters

• Findings highlight the efficacy of TXA in reducing blood loss and complement the current literature about the use of TXA in shoulder surgery.
• Larger randomised controlled trials (RCTs) with a low risk of bias are required for specific surgical shoulder procedures.

Study design

• 8 RCTs including 708 participants (406 received TXA and 302 received placebo) met eligibility criteria after a search on MEDLINE, Embase, PsycINFO, and Cochrane Library databases.
• Primary outcome: total blood loss (mL); secondary outcomes: non–bleeding-related outcomes.
• Funding: None disclosed.

Key results

• Pooled analysis showed a significant reduction with TXA vs placebo in:
  • estimated total blood loss (mean difference [MD], −209.66 mL; 95% CI, −389.11 to −30.21 mL; P=.02; I²=81%); and
  • post-operative blood loss as measured by drain output (MD, −84.8 mL; 95% CI, −140.04 to −29.56 mL; I²=60%).
• Haemoglobin reduction was seen with TXA vs placebo but was not statistically significant (MD, −0.33 g/dL; 95% CI, −0.69 to 0.03 g/dL; P=.07; I²=68%).
• This result became significant with sensitivity analysis excluding arthroscopic procedures (MD, −0.65 g/dL; 95% CI, −0.98 to −0.32 g/dL; P=.0001).
• A significant reduction in day 1 post-operative pain measured using visual analogue scale was seen with TXA (MD, −1.06; 95% CI, −1.48 to −0.65; P=.003; I²=88%).
• Operative time and length of stay did not differ significantly between the groups.

Limitations

• Heterogeneity among studies.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.