Effect of tranexamic acid on shoulder surgery: an updated meta-analysis of randomized studies

Background: The effect of tranexamic acid (TXA) has been proven to be effective in reducing blood loss in lower limb arthroplasty. The aim of this study is to investigate the effect of TXA in shoulder surgery with the updated studies. Materials and methods: A systematic review and meta-analysis of all the randomized controlled trials were conducted. We compared the outcomes of patients with and without TXA. The PubMed, MEDLINE, EMBASE, and CENTRAL databases were systematically searched for relevant studies. Results: A total of 14 studies, enrolling 1131 patients, were included for qualitative and quantitative analysis. Our results revealed that TXA was associated with a significant reduction in total volume blood loss (mean difference [MD]: -112.97, P = .0006), drain output (MD: - 81.90, P < .00001), hemoglobin changes (MD: -0.55, P = .02), shorter operative time (MD: -6.19, P = .01), and lower risk of hematoma formation (odds ratio: -0.20, P = .01). The postoperative visual analog scale pain score was also significantly better in the TXA group (MD: - 0.78, P < .00001). No significant difference was detected in length of hospital stay and incidence of thromboembolization. Conclusion: The usage of TXA in shoulder surgery appeared to be safe and effective in reducing blood loss without any significant complication. Level of evidence: Level II; Meta-Analysis (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.