Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial.
BACKGROUND
Patients undergoing reverse total shoulder arthroplasty (RTSA) are at risk of significant perioperative blood loss. To date, few studies have examined the effectiveness of tranexamic acid (TXA) to reduce blood loss in the setting of RTSA.


METHODS
In a prospective, double-blinded, single-surgeon trial, we analyzed 102 patients undergoing primary RTSA who were randomized to receive intravenous TXA (n = 53) or placebo (n = 49). Calculated total blood loss, drain output, and hemoglobin (Hb) drop were measured. Postoperative transfusions were recorded. Complications were assessed out to 6 weeks postoperatively.


RESULTS
Total blood loss was less for the TXA group (1122.4  ± 411.6 mL) than the placebo group (1472.6 ± 475.4 mL, P < .001). Total drain output was less for the TXA group (221.4 ± 126.2 mL) than the placebo group (371.9 ± 166.3 mL , P < .001). Total Hb loss was less in the TXA group (154.57 ± 60.29 g) compared with the placebo group (200.1 ± 65.5 g, P = .001). Transfusion rates differed significantly at postoperative day 1; however, overall transfusion rates did not vary significantly. Seven patients (14.3%) and 12 units were transfused in the placebo group compared with 3 patients (5.7%) and 3 units in the TXA group.


CONCLUSIONS
In this cohort of patients undergoing primary RTSA, TXA was effective in reducing total drain output, total Hb loss, and total blood loss compared with a placebo control.
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Alexander D
AD
Vara
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Denise M
DM
Koueiter
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Daphne E
DE
Pinkas
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Ashok
A
Gowda
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Brett P
BP
Wiater
Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA. Electronic address: j.michael.wiater@beaumont.org.
J Michael
JM
Wiater
D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D011184:Postoperative Period; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
antifibrinolytic; blood loss; blood transfusion; prospective randomized trial; reverse total shoulder arthroplasty; tranexamic acid