title: Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty.
abstract: BACKGROUND
  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. The purpose of this study was to evaluate the effect of TXA on postoperative blood loss after shoulder arthroplasty.
  
  
  METHODS
  A total of 111 patients (62 women; average age, 67 years) who underwent shoulder arthroplasty 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 into the wound at the completion of the case. All patients received a postoperative drain. Drain output representing postoperative blood loss, transfusion requirements, and change in hemoglobin level were recorded. All postoperative complications were noted.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In this cohort of patients, those treated with TXA experienced a significantly lower amount of postoperative blood loss and a significantly smaller change in hemoglobin level compared with those treated with placebo. Further work is required to determine the effectiveness and clinical significance of TXA in reducing transfusion requirements in shoulder arthroplasty and, more specifically, shoulder arthroplasty performed for complicated patients or for trauma and fracture patients.
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gillespie
authors.affiliation: The Cleveland Shoulder Institute, University Hospitals of Cleveland, Beachwood, OH, USA.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shishani
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sheeba
authors.initials: S
authors.lastname: Joseph
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Streit
authors.affiliation: The Cleveland Shoulder Institute, University Hospitals of Cleveland, Beachwood, OH, USA. Electronic address: reuben.gobezie@uhhospitals.org.
authors.forename: Reuben
authors.initials: R
authors.lastname: Gobezie
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
keywords: Tranexamic acid; hematocrit; hemoglobin; postoperative blood loss; shoulder arthroplasty