Effect of Tranexamic Acid on Hematologic Values and Blood Loss in Reverse Total Shoulder Arthroplasty

Abstract

Purpose . Use of tranexamic acid (TXA) in the setting of arthroplasty of the lower extremity has been previously described. The aim of this study was to evaluate the benefit of a single dose of TXA (500 mg vial) administered intravenously just prior to RTSA in an Asian population. Methods . The records of 48 patients (no TXA, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">24</mml:mn></mml:math>, versus TXA, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">24</mml:mn></mml:math>) that underwent RTSA for cuff tear arthropathy were retrospectively reviewed. All patients had a Hemovac drain positioned for 2 days after surgery. Hemoglobin (Hb) and hematocrit (Hct) were checked on postoperative day 2 and compared with preoperative levels. Results . Hematologic change on postoperative day 2 as determined by Hb level after surgery was statistically lower in the TXA group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mn fontstyle="italic">2.8</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.8</mml:mn></mml:math> versus <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mn fontstyle="italic">2.1</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.8</mml:mn></mml:math> (mg/dL), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.006</mml:mn></mml:math>). Mean fall in Hct level was also significantly less in the TXA group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mn fontstyle="italic">8.0</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">2.5</mml:mn></mml:math> versus <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mn fontstyle="italic">6.1</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">2.6</mml:mn></mml:math> (L/L), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.012</mml:mn></mml:math>). Total Hemovac drainage tended to be lower in the TXA group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mn fontstyle="italic">263.4</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">129.3</mml:mn></mml:math> versus <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mn fontstyle="italic">203.5</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">84.2</mml:mn></mml:math> (ml), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.064</mml:mn></mml:math>). TXA was found to have no noticeable side effects. Conclusion . The use of a single intravenous dose of TXA immediately prior to RTSA reduces hematologic deterioration postoperatively and the amount of Hemovac drainage. TXA could avoid unnecessary transfusion and its associated medical side effects and cost.