Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to significantly reduce blood loss and transfusion requirements after total knee and hip arthroplasty. These authors evaluated the effect of TXA on postoperative blood loss after shoulder arthroplasty in 111 patients (62 women; average age, 67 years) who underwent shoulder arthroplasty.
Patients were prospectively randomized in double-blinded fashion to receive either 100 mL of normal saline or 100 mL of normal saline with 2 g TXA by topical application. Before closure of the deltopectoral interval, each patient in the treatment group had 100 mL of normal saline infused with 2 g of TXA poured into the surgical wound and left in place for 5 minutes. The control group had 100 mL of normal saline poured into the wound and left in place for the same duration. Neither the patient nor the surgeon had knowledge of whether TXA solution or placebo was being administered, and this blinding remained in place until analysis of data at completion of the study. Before closure of the deltopectoral interval, a standard Hemovac drain was placed deep to the deltoid muscle. The estimated blood loss (EBL) for the procedure was determined at this point, and all additional blood loss through the drain was recorded for the purposes of the study.
The average blood loss recorded after surgery was 170 mL in the placebo group and 108 mL in the TXA group (P ..017). The average change in hemoglobin level was 2.6 g/dL in the placebo group and 1.7 g/dL in the TXA group (P < .001). There were no transfusion requirements or postoperative complications noted in either group.
The protocol used here is the topical application of TXA for 5 minutes near the end of the procedure. Alternatively, TXA can be administered intravenously with a gram at the beginning and a gram at the end of the case. While there is a theoretical risk of thromboembolic events when intravenous TXA is
given because of its antifibrinolytic properties; a number of lower extremity arthroplasty studies have not demonstrated an increased incidence of these events.
given because of its antifibrinolytic properties; a number of lower extremity arthroplasty studies have not demonstrated an increased incidence of these events.
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