Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials

Background: Tranexamic acid (TXA) reduces blood loss in knee and hip arthroplasty, but the effectiveness in shoulder arthroplasty is unknown. This study aimed to evaluate current level I randomized controlled trials examining the efficacy of TXA in primary shoulder arthroplasty. Methods: A protocol...

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Autores principales:	DingYuan Fan, MBBS, Jia Ma, MD, PhD, Lei Zhang, MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Tranexamic acid Shoulder Arthroplasty Shoulder arthroplasty Meta-analysis Surgery RD1-811
Acceso en línea:	https://doaj.org/article/d272e13f4c4347c8a2fa1eb95f4e92ef
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spelling	oai:doaj.org-article:d272e13f4c4347c8a2fa1eb95f4e92ef2021-11-22T04:31:39ZTranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials2666-639110.1016/j.xrrt.2021.05.005https://doaj.org/article/d272e13f4c4347c8a2fa1eb95f4e92ef2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666639121000535https://doaj.org/toc/2666-6391Background: Tranexamic acid (TXA) reduces blood loss in knee and hip arthroplasty, but the effectiveness in shoulder arthroplasty is unknown. This study aimed to evaluate current level I randomized controlled trials examining the efficacy of TXA in primary shoulder arthroplasty. Methods: A protocol for the study was designed and registered with PROSPERO (CRD42021230398). The PubMed, Embase, and Cochrane Library databases were searched using the following search strategy: “shoulder replacement” OR “shoulder arthroplasty” OR “reverse shoulder arthroplasty” AND “tranexamic acid.” All randomized controlled trials were included in this study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was followed. Outcomes include blood loss, drain output, hemoglobin, thromboembolic complications, and blood transfusion. Results: Five randomized controlled trials of 435 patients (219 patients in the TXA group and 216 patients in the non-TXA group) were included in the systematic review. The results indicated that the group using TXA had less total blood loss (MD, −249.56 mL; 95% confidence interval [CI] −347.60 to −151.52), less drainage output (MD, −113.72 mL; −155.92 to −71.52 95% CI), and less of a change in hemoglobin (MD, −0.68 g/dl; −0.94 to −0.42 g/dl 95% CI). No significant differences in blood transfusion (risk ratio 0.40; −0.11 to 1.45 95% CI) or thromboembolic events (risk ratio 0.13, 0.02 to 1.12 95% CI) were observed. Subgroup analyses showed that there was no significant difference in total blood loss, drainage output, or change in hemoglobin between single dose and multiple doses. Conclusions: TXA in primary shoulder arthroplasty can reduce blood loss, drain output, and hemoglobin changes. Subgroup analysis showed that multiple TXA doses have similar results compared with single dose in primary shoulder arthroplasty. More randomized controlled trials comparing different administration routes of TXA in primary and revision shoulder arthroplasty are required.DingYuan Fan, MBBSJia Ma, MD, PhDLei Zhang, MD, PhDElsevierarticleTranexamic acidShoulderArthroplastyShoulder arthroplastyMeta-analysisSurgeryRD1-811ENJSES Reviews, Reports, and Techniques, Vol 1, Iss 4, Pp 344-352 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tranexamic acid Shoulder Arthroplasty Shoulder arthroplasty Meta-analysis Surgery RD1-811
spellingShingle	Tranexamic acid Shoulder Arthroplasty Shoulder arthroplasty Meta-analysis Surgery RD1-811 DingYuan Fan, MBBS Jia Ma, MD, PhD Lei Zhang, MD, PhD Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
description	Background: Tranexamic acid (TXA) reduces blood loss in knee and hip arthroplasty, but the effectiveness in shoulder arthroplasty is unknown. This study aimed to evaluate current level I randomized controlled trials examining the efficacy of TXA in primary shoulder arthroplasty. Methods: A protocol for the study was designed and registered with PROSPERO (CRD42021230398). The PubMed, Embase, and Cochrane Library databases were searched using the following search strategy: “shoulder replacement” OR “shoulder arthroplasty” OR “reverse shoulder arthroplasty” AND “tranexamic acid.” All randomized controlled trials were included in this study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was followed. Outcomes include blood loss, drain output, hemoglobin, thromboembolic complications, and blood transfusion. Results: Five randomized controlled trials of 435 patients (219 patients in the TXA group and 216 patients in the non-TXA group) were included in the systematic review. The results indicated that the group using TXA had less total blood loss (MD, −249.56 mL; 95% confidence interval [CI] −347.60 to −151.52), less drainage output (MD, −113.72 mL; −155.92 to −71.52 95% CI), and less of a change in hemoglobin (MD, −0.68 g/dl; −0.94 to −0.42 g/dl 95% CI). No significant differences in blood transfusion (risk ratio 0.40; −0.11 to 1.45 95% CI) or thromboembolic events (risk ratio 0.13, 0.02 to 1.12 95% CI) were observed. Subgroup analyses showed that there was no significant difference in total blood loss, drainage output, or change in hemoglobin between single dose and multiple doses. Conclusions: TXA in primary shoulder arthroplasty can reduce blood loss, drain output, and hemoglobin changes. Subgroup analysis showed that multiple TXA doses have similar results compared with single dose in primary shoulder arthroplasty. More randomized controlled trials comparing different administration routes of TXA in primary and revision shoulder arthroplasty are required.
format	article
author	DingYuan Fan, MBBS Jia Ma, MD, PhD Lei Zhang, MD, PhD
author_facet	DingYuan Fan, MBBS Jia Ma, MD, PhD Lei Zhang, MD, PhD
author_sort	DingYuan Fan, MBBS
title	Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
title_short	Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
title_full	Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
title_fullStr	Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
title_full_unstemmed	Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials
title_sort	tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level i randomized controlled trials
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/d272e13f4c4347c8a2fa1eb95f4e92ef
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Tranexamic acid achieves less blood loss volume of in primary shoulder arthroplasty: a systematic review and meta-analysis of level I randomized controlled trials

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