Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2023; 11(13): 2992-3001
Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.2992
Efficacy and safety of intravenous tranexamic acid in total shoulder arthroplasty: A meta-analysis
Hua-Mei Deng
Hua-Mei Deng, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Author contributions: Deng HM designed and conducted the study; Deng HM read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Mei Deng, MM, Professor, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. szydenghm@126.com
Received: January 9, 2023
Peer-review started: January 9, 2023
First decision: February 20, 2023
Revised: March 8, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: May 6, 2023
Abstract
BACKGROUND

Total shoulder arthroplasty (TSA) results in a large amount of perioperative blood loss due to severe trauma.

AIM

To investigate the safety and efficacy of intravenous tranexamic acid (TXA) in TSA.

METHODS

We searched the PubMed, Cochrane Library, Embase and Web of Science databases for randomized controlled trials (RCTs) on the use of TXA in TSA. And all the results were checked and assessed by Reference Citation Analysis (https://www.referencecitationanalysis.com/). A meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio (OR) or weighted mean difference (WMD) of related outcome indicators.

RESULTS

A total of 5 RCTs with level 1 evidence were included. There were 369 cases, with 186 in the TXA group and 183 in the placebo group. The meta-analysis showed that TXA can significantly reduce total blood loss during the perioperative period [WMD = -249.56, 95% confidence interval (CI): -347.6 to -151.52, P < 0.0001], and the incidence of adverse reactions was low (OR = 0.36, 95%CI: 0.16-0.83, P = 0.02). Compared with the placebo group, the TXA group had significantly less total haemoglobin loss (WMD = -34.39, 95%CI: -50.56 to -18.22), less haemoglobin fluctuation before and after the operation (WMD = -0.6, 95%CI: -0.93 to -0.27) and less 24-h drain output (WMD = -136.87, 95%CI: -165.87 to -106.49). There were no significant differences in the operation time (P = 0.11) or hospital length of stay (P = 0.30) between the two groups.

CONCLUSION

The application of intravenous TXA in the perioperative period of TSA can significantly reduce the total volume of perioperative blood loss and reduce the incidence of adverse reactions, so TXA is worthy of widespread clinical use.

Keywords: Intravenous, Tranexamic acid, Total shoulder arthroplasty, Placebo, Meta-analysis

Core Tip: The development and application of total shoulder arthroplasty (TSA) have been slower than those of total knee and total hip arthroplasty, and there is still a lack of advanced evidence-based evidence about the application of tranexamic acid (TXA) in the perioperative period of TSA. Therefore, a meta-analysis was conducted to determine the efficacy and safety of intravenous TXA in the perioperative period of TSA.