Friday, April 29, 2016

Blood loss after shoulder arthroplasty - effectiveness of Tranexamic acid

Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty

These authors conducted a retrospective comparison of 77 primary total shoulder arthroplasties (TSA) and 94 reverse total shoulder arthroplasties (RTSA) 1 gm of Tranexamic acid  (TXA) had been administered intravenously in 35 TSA and 42 RTSA patients after anesthetic induction.  Patients who had a history of thromboembolic disease were excluded from the TXA group.

TSA patients having TXA had less total blood loss (679 mL vs. 910 mL; P < .001), less change in Hgb (1.8 mg/dL vs. 2.6 mg/dL; P < .001), less of a drop in Hct (5.2 vs. 7.0; P < .001), and less drain output (99 mL vs. 235 mL; P < .001)

RTSA patients having TXA had less total blood loss (791 mL vs. 959 mL; P < .001), less change in Hgb (2.3 mg/dL vs. 2.9 mg/dL; P < .001), less change in Hct (6.4 vs. 8.3; P < .001), and less drain output (180 mL vs. 370 mL; P < .001).

Comment: This study provides some additional evidence of the effectiveness of TXA in reducing bleeding from shoulder arthroplasty. Reducing bleeding may be  a benefit more in terms of reducing the formation of a hematoma around the shoulder than in reducing blood loss per se.

It is unclear from the study's methods why only half of the surgeon's cases received TXA - this information is important to understanding the difference between the patients that did and did not receive TXA.

This study did not investigate the effect of TXA on perioperative complications, including wound healing, hematoma formation, or VTE. 

TXA is used increasingly for patients having shoulder arthroplasty. Questions still remain regarding indications, contraindications, dosage and potential risks.


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