Tranexamic acid administration for anatomic and reverse total shoulder arthroplasty: a systematic review and meta-analysis

Background: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss and risk of blood transfusion. Evidence establishing its efficacy in total shoulder arthroplasty (TSA) is limited. The current study evaluated the effect of TXA on perioperative blood loss and transfusion risk after TSA. Methods: A systematic review and meta-analysis of TXA administration for TSA was performed, and 6 studies with a total of 680 patients were found. Data on change in hemoglobin, drain output, total blood loss, and transfusion were extracted. Meta-analysis was performed with stratification into reverse and anatomic TSA subgroups. Results: TXA administration was associated with decreased change in hemoglobin (−0.63 g/dL; 95% CI, −0.87 to −0.39 g/dL; P <.00001), drain output (−112.05 mL; 95% CI, −182.29 to −41.81 mL; P <.0001), and total blood loss (−231.87 mL; 95% CI, −334.23 to −129.48 mL; P <.00001) after reverse TSA. There was a trend toward reduction in transfusion rate after reverse TSA (−4%; 95% CI, −8% to 0%; P =.06). TXA administration was associated with reduced drain output after anatomic TSA (−123.07 mL; 95% CI, −163.93 to −82.20 mL; P < 0.00001). TXA administration was not associated with decreased transfusion rate after anatomic TSA. Data to evaluate the effect of TXA on change in hemoglobin and total blood loss after anatomic TSA were insufficient. Conclusions: Routine administration of TXA reduces perioperative blood loss and may reduce the risk of transfusion after reverse TSA. Future studies are needed to further characterize its effect on the risk of transfusion after reverse TSA and efficacy in anatomic TSA.