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

ABSTRACT: 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.The records of 48 patients (no TXA, n = 24, versus TXA, n = 24) 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.Hematologic change on postoperative day 2 as determined by Hb level after surgery was statistically lower in the TXA group (2.8 ± 0.8 versus 2.1 ± 0.8 (mg/dL), P = 0.006). Mean fall in Hct level was also significantly less in the TXA group (8.0 ± 2.5 versus 6.1 ± 2.6 (L/L), P = 0.012). Total Hemovac drainage tended to be lower in the TXA group (263.4 ± 129.3 versus 203.5 ± 84.2 (ml), P = 0.064). TXA was found to have no noticeable side effects.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.

SUBMITTER: Kim SH

PROVIDER: S-EPMC5551469 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:Hypothesis and backgroundThere is no differences in abduction, internal rotation, or external rotation strength after reverse total shoulder arthroplasty (rTSA) with or without subscapularis repair. Repair of the subscapularis can be effective in the setting of rTSA. However, consensus has yet to be reached on whether postoperative strength after rTSA differs based on subscapularis management. The purpose of this review is to evaluate shoulder strength outcomes after rTSA with and without subscapularis tendon repair.MethodsA comprehensive literature review was conducted using the key terms "subscapularis" AND "reverse total shoulder arthroplasty" AND "muscle strength" in PubMed, Embase, Web of Science, Cochrane Reviews and Trials, and Scopus. Original, English-language studies evaluating shoulder strength outcomes after rTSA published from January 1, 2000, to present were evaluated. Strength outcomes reported included abduction strength (kg) and internal rotation strength (kg) using an electric spring balance and external rotation strength (lb) using a handheld dynamometer. Heterogeneity of data in the included studies did not allow for meta-analysis.ResutsThe search yielded 4253 unique results, which were screened for inclusion according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two articles met eligibility criteria and were included in the final full-text review. A total of 267 shoulders were represented, 111 with subscapularis repair and 156 without subscapularis repair. No significant differences in abduction (P = .39), internal rotation (P = .09), and external rotation (P = .463) strength were observed between subscapularis repair and nonrepair groups.ConclusionThere were no differences in abduction, internal rotation, or external rotation strength after rTSA with or without subscapularis repair. The literature on postoperative strength outcomes after rTSA is limited, and further study in this area is warranted.

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

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