These authors assessed the utility of topical thrombin in TSA, and compared the effectiveness of topical thrombin to intravenous tranexamic acid.
They queried an institutional database to identify 283 patients having primary anatomic shoulder arthroplasty.
There was no statistically significant difference in the baseline characteristics with age, BMI or ASA.
Hemoglobin loss (Hgb-loss) was calculated by the following equation: (k1 x Height^3 + k2 x Weight + k3) x (Hgb-initial – Hgb-end) x 0.001 + Hgb-transfused, where k1 = 0.3669 or 0.3561, k2 = 0.03219 or 0.03308, and k3 = 0.6041 or 0.1833 for males and females, respectively.
Total volume loss was calculated by: 1000 x (Hgb-loss/ Hgb-initial)
Postoperative Hgb (mg/dL) was higher in the group that received either IV TXA or thrombin compared to no hemostatic agents.
Calculated blood loss in TSA was significantly higher in the group without hemostatic agents, 369.8 ml compared to IV TXA or topical thrombin, 344.3 ml and 342.9 ml.
Operative time was highest in the group that received no hemostatic agents.
Transfusion rate for TSA treated with IV TXA or topical thrombin was equivalent (2.2%) but significantly lower than no intervention group (12%) (p=0.01). Odd’s ratio for transfusion with IV TXA was 0.16, and topical thrombin was 0.1 (95% CI 0.02-0.42, p = 0.02).
The authors concluded that topical thrombin is an effective adjunct to reduce blood loss and transfusion risk after total shoulder arthroplasty (TSA) and a reasonable intraoperative alternative for TXA for patients with contraindication to IV TXA.
Comment: While blood loss is not usually a problem after shoulder arthroplasty; however, bleeding into the wound after surgery can cause pain and even neurological problems from nerve compression. Whether or not TXA is contraindicated in some patients because of prior thromboembolic events remains uncertain. This study suggests that topical thrombin (or possibly topical TXA) may have benefit in those patients not receiving IV TXA.
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