Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis

作者全名："Sun, Yiyuan; Xiao, Dan; Fu, Weili; Cai, Wufeng; Huang, Xihao; Li, Qi; Li, Jian"

作者地址："[Sun, Yiyuan] Sichuan Univ, Day Surg Ctr, West China Hosp, Chengdu 610041, Peoples R China; [Xiao, Dan] ChongQing Med Univ, Yong Chuan Hosp, Chongqing 402160, Peoples R China; [Fu, Weili; Cai, Wufeng; Huang, Xihao; Li, Qi; Li, Jian] Sichuan Univ, Orthoped Res Inst, Dept Orthoped, West China Hosp, Chengdu 610041, Peoples R China"

通信作者："Fu, WL (通讯作者)，Sichuan Univ, Orthoped Res Inst, Dept Orthoped, West China Hosp, Chengdu 610041, Peoples R China."

来源：JOURNAL OF CLINICAL MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000896430300001

JCR分区：Q1

影响因子：3.9

年份：2022

卷号：11

期号：23

开始页：　

结束页：　

文献类型：Review

关键词：tranexamic acid; arthroscopy; shoulder; rotator cuff repair; hemarthrosis

摘要："Background: Visual clarity during shoulder arthroscopy can ensure an efficient and effective performance of the procedure, and it is highly related to bleeding without a tourniquet. Tranexamic acid (TXA) is widely used in adult reconstruction procedures; however, its use in shoulder arthroscopic operations is a relatively novel topic. Purpose: To analyze the available literature on visual clarity, blood loss, pain control, functional outcomes, and complications after the administration of tranexamic acid in shoulder arthroscopic surgery. Methods: A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of shoulder arthroscopic surgery. The literature search included the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The primary outcomes included visual clarity, blood loss, and visual analog scale scores for pain. Secondary outcomes were operative time, irrigation amount used, postoperative shoulder swelling, the need for pressure increase, mean arterial pressure (MAP), functional outcomes, postoperative adverse effects such as deep venous thrombosis, and pulmonary embolism. The outcomes were pooled to perform a meta-analysis. Results: Seven prospective randomized controlled trials met the inclusion criteria for analysis. All of the included studies performed arthroscopic rotator cuff repair. No significant difference in visual clarity was observed (SMD (standardized mean difference), 0.45 [95% CI(confidence interval), -0.68, 1.59]; p = 0.44) nor in pain score (MD (mean difference), -0.46 [95% CI, -0.97, 0.05]; p = 0.08) between the TXA group and the control group. Two studies found no significant difference in blood loss between the TXA group and the control group. The meta-analysis from five studies demonstrated no significant difference between the TXA and control groups in operative time (MD, -3.51 [95% CI, -15.82, 8.80]; p = 0.58) or irrigation amount used (MD, -2.53 [95% CI, -5.93, 0.87]; p = 0.14). Two trials reported different statistical results in postoperative shoulder swelling. No significant differences regarding the need for pressure increase and MAP were reported between groups. No wound complications or infections or cardiac, thrombotic, or thromboembolic complications were recorded in either group. Conclusion: The use of intravenous or local TXA in shoulder arthroscopic surgery did not increase complications or thromboembolic events, but TXA had no obviously effect of reducing bleeding to obtain a clear visual field or pain release in patients undergoing shoulder arthroscopic surgery."

基金机构："National Natural Science Foundation of China [81972123, 82172508]; 1.3.5 Project for Disciplines of Excellence of West China Hospital Sichuan University [ZYJC21030, ZY2017301]; 1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University [2019HXFH039]"

基金资助正文："This research was funded by National Natural Science Foundation of China (81972123, 82172508); 1.3.5 Project for Disciplines of Excellence of West China Hospital Sichuan University (ZYJC21030, ZY2017301); 1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH039)."