title: Tranexamic acid decreases blood loss after total shoulder arthroplasty.
abstract: BACKGROUND
  Tranexamic acid (TXA) significantly decreases blood loss and transfusion rates after total hip and total knee arthroplasty. The purpose of this study was to determine the effects of intravenous TXA on blood loss and patient outcomes after total shoulder arthroplasty (TSA).
  
  
  METHODS
  TXA was used in 106 consecutive patients undergoing primary anatomic and reverse TSA with a dose of 20 mg/kg intravenously (TXA group) and compared with the previous consecutive 88 patients without TXA (non-TXA group). All patients had a blood sample drawn for a hemoglobin and hematocrit determination the morning after surgery. Analysis of variance and χ(2) techniques were used to analyze study hypotheses.
  
  
  RESULTS
  Statistically significant differences in both hemoglobin loss (TXA group Δ = 2.13 vs. non-TXA group Δ = 2.63; P = .01) and hematocrit loss (TXA group Δ = 6.4 vs. non-TXA group Δ = 8.14; P < .01) were seen in the TXA group compared with the non-TXA group. In patients receiving TXA, there were statistically significant decreases in the time spent in the recovery room (mean, TXA group 69 minutes vs. non-TXA group 87 minutes; P < .02) and total length of hospitalization (mean, TXA group 1.18 days vs. non-TXA group 1.4 days; P = .01). Two patients in the TXA group received a blood transfusion, whereas 6 patients in the non-TXA group did.
  
  
  CONCLUSIONS
  TXA 20 mg/kg intravenously given just before primary anatomic and reverse TSA results in statistically significant reductions in blood loss. Patients spent 21% less time in the recovery room and had a 16% shorter hospitalization, resulting in financial savings for the hospital.
authors.affiliation: Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA. Electronic address: friedman@musc.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Friedman
authors.affiliation: Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Gordon
authors.affiliation: Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: R Bryan
authors.initials: RB
authors.lastname: Butler
authors.affiliation: Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mock
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Dumas
mesh_terms: D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Tranexamic acid; anatomic shoulder arthroplasty; blood loss; blood transfusion; patient outcomes; reverse shoulder arthroplasty; total shoulder arthroplasty