Total shoulder arthroplasty - how safe is tranexamic acid?

Administration of tranexamic acid during total shoulder arthroplasty is not associated with

increased risk of complications in patients with a history of thrombotic events

These authors point out that tranexamic acid (TXA) has been shown to reduce blood loss and transfusion risk in shoulder arthroplasty, but that concerns exist regarding its safety in patients with a history of thrombotic events. 

They used national claims data to study the safety of TXA administration in shoulder arthroplasty patients with a history of thrombotic events such as myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke. 

Overall, TXA was used in 13.7% (n . 9735) of patients, whereas 10.5% (n . 7475) of patients had a history of a thrombotic event.

TXA use (compared with no TXA use) in patients without a history of thrombotic events was associated with decreased odds of blood transfusions (OR, 0.48), whereas no increased odds for complications were observed (OR, 0.83). 

Similar results were observed in patients with a history of thrombotic events.

Moreover, in this subgroup, TXA use was associated with a 8.9% reduction in hospitalization cost.

As shown below, patients with a history of thromboembolic events had a higher risk of a thromboembolic event after shoulder arthroplasty, but TXA use did not increase this use.

 Comment: It is important to have these data to support the use of TXA in patients at increased risk for thromboembolic events (TEEs). Note that according to these statistics 4.6 patients out of 100 with a prior history of TEEs wold have a new TEE. One of those patients might be tempted to sue the surgeon that gave the TXA. These data suggest that the prescribing surgeon may actually be reducing the risk of a new TEE.

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