Saturday, March 10, 2018

Reducing the bleeding after total shoulder replacement

Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis

These authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive tranexamic acid (TXA)

The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events.

They identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-

TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate, less change in hemoglobin, and reduced estimated blood loss, especially in patients with RTSA.

All six included studies reported data on the proportion of  patients who developed complications and thromboembolic events during the study period. There were no significant differences in overall complications or thromboembolic events between the TXA and the non-TXA groups.

Comment: It is uncommon for our patients to need a transfusion after a shoulder arthroplasty. In our view, the principal rationale for tranexamic acid is to reduce bleeding into the arthroplasty after surgery - such bleeding can increase pain and interfere with the achievement of early range of motion. We use one dose at the beginning and one at the end of the case. Contraindications for us are prior thromboembolic events, evidence of coronary artery or cerebrovascular disease, and diagnosis of cancer. 

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