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A Single Dose of Tranexamic Acid Reduces Blood Loss After Reverse and Anatomic Shoulder Arthroplasty: A Randomized Control Trial

Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland. Sydney Shoulder Research Institute, Sydney, NSW, Australia. Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland. Electronic address: benoit.borner@hcuge.ch. The Orthopaedic Group, Melbourne, VIC, Australia. Division of Orthopaedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland. Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia.

Journal of shoulder and elbow surgery. 2021
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Abstract
BACKGROUND Hematoma formation and blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. MATERIALS AND METHODS We conducted a double-blinded randomized controlled trial comparing intravenous TXA to placebo in 60 patients undergoing primary anatomic and reverse shoulder arthroplasty. 29 patients received a placebo whilst 31 received a single dose of 2g of intravenous TXA. Patient demographics as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay and pain scores were recorded. Patients were followed up for 12 weeks to assess for complications. RESULTS Patients who received TXA had lower drain tube outputs at all time points, 41ml compared to 133ml at 6 hours, 75ml compared to 179ml at 12 hours and 94ml compared to 226ml at 24 hours (all P<0.001). They also had higher postoperative Hb (12.3 vs 11.4; P=0.009), lower change in Hb (1.7 vs 2.3; P=0.011), lower total Hb loss (0.078g vs 0.103g; P=0.042) and blood volume loss (0.55L vs 0.74L; P=0.021), higher postoperative hematocrit (36.7 vs 34.6; P=0.020) and lower hematocrit change (5.4 vs 7.6; P=0.022). There was no significant difference in pain scores or length of hospital stay and no patients required a transfusion. CONCLUSION A single dose of 2g intravenous Tranexamic Acid decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. There were no differences detected in occurrence of complications, need for transfusion, pain scores or length of hospital stay. With the mounting evidence now available, patients undergoing an elective primary shoulder arthroplasty should be given intravenous TXA to decrease peri-operative blood loss.
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Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine