Tuesday, October 4, 2016

What is the value of Tranexamic acid in shoulder arthroplasty?

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

These authors conducted a retrospective comparison of 77 total shoulder arthroplasties (TSAs) and 94 reverse total shoulders (RTSAs) performed between August 2013 and March 2015. In 2014, the authors began using 1 gram tranexamic acid (TXA) administered intravenously after anesthesia induction in 35 TSA and 42 RTSA patients. 

They found that the TXA TSA group had significantly lower 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), and less change in Hct (5.2 vs. 7.0; P < .001). Similarly, the TXA RTSA group had significantly less total blood loss TXA (791 mL vs. 959 mL; P < .001), and less change in Hgb (2.3 mg/dL vs. 2.9 mg/dL; P < .001), and less change in Hct (6.4 vs. 8.3; P < .001). The TXA group also had less drain output in both for TSA (99 mL vs. 235 mL; P < .001) and RTSA (180 mL vs. 370 mL; P < .001). Three of 92 RTSA patients (3.3%) and 1 of 77 TSA patients (1.3%) received a blood transfusion, with 2 of the 4 patients having received TXA.

Comment: This study uses historical controls to show that patients having shoulder arthroplasty after 2014 (at which time the authors began using TXA) had less perioperative blood loss than those having shoulder arthroplasty prior to 2014. 

No complications could be attributed to the use of TXA

While the two groups were matched with respect to some characteristics, one cannot be sure that other factors, such as operative time, were the same for both groups. 

In these days of cost containment, the cost effectiveness of different interventions is important. The cost vs. benefit of TXA administration is not demonstrated in this study: (a) the cost of TXA administration was not provided and (b) the transfusion rate was low in this series and was not different for those patients receiving TXA. This is in large part due to the low transfusion rate for shoulder arthroplasties performed by this experienced surgical team.