Clinical effectiveness and safety of tranexamic acid in arthroscopic rotator cuff repair: a meta-analysis_West China Medical Journal

Authors：

 ZHANG Huiwei ¹ , LIU Kai ²

1. Department of Anaesthesia, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;
2. Department of Joint Surgery, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

ZHANG Huiwei, Email: 286482645@qq.com

Keywords：

Tranexamic acid; shoulder arthroscopy; rotator cuff repair

DOI：

10.7507/1002-0179.202404200

Video：

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Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.

Citation： ZHANG Huiwei, LIU Kai. Clinical effectiveness and safety of tranexamic acid in arthroscopic rotator cuff repair: a meta-analysis. West China Medical Journal, 2024, 39(10): 1551-1556. doi: 10.7507/1002-0179.202404200 Copy

1.	Takahashi R, Kajita Y, Iwahori Y, et al. Tranexamic acid has no effect on postoperative pain control after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled trial. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2023, 33: 32-35.
2.	Hartland AW, Teoh KH, Rashid MS. Clinical effectiveness of intraoperative tranexamic acid use in shoulder surgery: a systematic review and meta-analysis. Am J Sports Med, 2021, 49(11): 3145-3154.
3.	Pecold J, Al-Jeabory M, Krupowies M, et al. Tranexamic acid for shoulder arthroplasty: a systematic review and meta-analysis. J Clin Med, 2021, 11(1): 48.
4.	Liu YF, Hong CK, Hsu KL, et al. Intravenous administration of tranexamic acid significantly improved clarity of the visual field in arthroscopic shoulder surgery. A prospective, double-blind, and randomized controlled trial. Arthroscopy, 2020, 36(3): 640-647.
5.	Bayram E, Yıldırım C, Ertürk AK, et al. Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: a double-blind, randomized-controlled study. Jt Dis Relat Surg, 2021, 32(1): 115-121.
6.	Nicholson TA, Kirsch JM, Churchill R, et al. The effect of tranexamic acid for visualization on pump pressure and visualization during arthroscopic rotator cuff repair: an anonymized, randomized controlled trial. J Shoulder Elbow Surg, 2022, 31(11): 2211-2216.
7.	Mackenzie SP, Spasojevic M, Smith M, et al. The effect of single-dose, preoperative intravenous tranexamic acid on early postoperative pain scores after rotator cuff repair: a double-blind, randomized controlled trial. J Shoulder Elbow Surg, 2022, 31(7): 1399-1408.
8.	高华利, 张杰超, 何勇, 等. 氨甲环酸控制肩关节镜术后关节腔出血的临床研究. 中国骨伤, 2020, 33(3): 238-241.
9.	Takahashi R, Kajita Y, Iwahori Y, et al. Tranexamic acid administration for arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled trial. J Orthop Sci, 2023, 28(2): 328-332.
10.	Shin HJ, You HS, Lee K, et al. Intravenous tranexamic acid improves visual clarity during synovectomy in patients undergoing arthroscopic rotator cuff repair: a double-blind, randomized controlled study. Arthroscopy, 2024, 40(5): 1409-1419.
11.	van Montfoort DO, van Kampen PM, Huijsmans PE. Epinephrine diluted saline-irrigation fluid in arthroscopic shoulder surgery: a significant improvement of clarity of visual field and shortening of total operation time. A randomized controlled trial. Arthroscopy, 2016, 32(3): 436-444.
12.	Nemani VM, Frank RM, Reinhardt KR, et al. Popliteal venotomy during posterior cruciate ligament reconstruction in the setting of a popliteal artery bypass graft. Arthroscopy, 2012, 28(2): 294-299.
13.	Bierke S, Häner M, Bentzin M, et al. The use of tranexamic acid reduces blood loss in osteotomy at knee level: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2022, 30(12): 4104-4114.
14.	Tandogan RN, Polat M, Beyzadeoglu T, et al. Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 519-528.
15.	Thery C, Antoni M, Dujeux C, et al. Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair. Eur J Orthop Surg Traumatol, 2023, 33(7): 2865-2871.
16.	Günseren KÖ, Demir A, Celen S, et al. A cut-off value for the operation time and other risk factors in terms of the infection risk for flexible ureterorenoscopy. Int J Clin Pract, 2021, 75(4): e13846.
17.	Calvo E, Torres MD, Morcillo D, et al. Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Arch Orthop Trauma Surg, 2019, 139(5): 669-674.
18.	Carbone A, Poeran J, Zubizarreta N, et al. Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events. J Shoulder Elbow Surg, 2021, 30(1): 104-112.

1. Takahashi R, Kajita Y, Iwahori Y, et al. Tranexamic acid has no effect on postoperative pain control after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled trial. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2023, 33: 32-35.
2. Hartland AW, Teoh KH, Rashid MS. Clinical effectiveness of intraoperative tranexamic acid use in shoulder surgery: a systematic review and meta-analysis. Am J Sports Med, 2021, 49(11): 3145-3154.
3. Pecold J, Al-Jeabory M, Krupowies M, et al. Tranexamic acid for shoulder arthroplasty: a systematic review and meta-analysis. J Clin Med, 2021, 11(1): 48.
4. Liu YF, Hong CK, Hsu KL, et al. Intravenous administration of tranexamic acid significantly improved clarity of the visual field in arthroscopic shoulder surgery. A prospective, double-blind, and randomized controlled trial. Arthroscopy, 2020, 36(3): 640-647.
5. Bayram E, Yıldırım C, Ertürk AK, et al. Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: a double-blind, randomized-controlled study. Jt Dis Relat Surg, 2021, 32(1): 115-121.
6. Nicholson TA, Kirsch JM, Churchill R, et al. The effect of tranexamic acid for visualization on pump pressure and visualization during arthroscopic rotator cuff repair: an anonymized, randomized controlled trial. J Shoulder Elbow Surg, 2022, 31(11): 2211-2216.
7. Mackenzie SP, Spasojevic M, Smith M, et al. The effect of single-dose, preoperative intravenous tranexamic acid on early postoperative pain scores after rotator cuff repair: a double-blind, randomized controlled trial. J Shoulder Elbow Surg, 2022, 31(7): 1399-1408.
8. 高华利, 张杰超, 何勇, 等. 氨甲环酸控制肩关节镜术后关节腔出血的临床研究. 中国骨伤, 2020, 33(3): 238-241.
9. Takahashi R, Kajita Y, Iwahori Y, et al. Tranexamic acid administration for arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled trial. J Orthop Sci, 2023, 28(2): 328-332.
10. Shin HJ, You HS, Lee K, et al. Intravenous tranexamic acid improves visual clarity during synovectomy in patients undergoing arthroscopic rotator cuff repair: a double-blind, randomized controlled study. Arthroscopy, 2024, 40(5): 1409-1419.
11. van Montfoort DO, van Kampen PM, Huijsmans PE. Epinephrine diluted saline-irrigation fluid in arthroscopic shoulder surgery: a significant improvement of clarity of visual field and shortening of total operation time. A randomized controlled trial. Arthroscopy, 2016, 32(3): 436-444.
12. Nemani VM, Frank RM, Reinhardt KR, et al. Popliteal venotomy during posterior cruciate ligament reconstruction in the setting of a popliteal artery bypass graft. Arthroscopy, 2012, 28(2): 294-299.
13. Bierke S, Häner M, Bentzin M, et al. The use of tranexamic acid reduces blood loss in osteotomy at knee level: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2022, 30(12): 4104-4114.
14. Tandogan RN, Polat M, Beyzadeoglu T, et al. Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 519-528.
15. Thery C, Antoni M, Dujeux C, et al. Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair. Eur J Orthop Surg Traumatol, 2023, 33(7): 2865-2871.
16. Günseren KÖ, Demir A, Celen S, et al. A cut-off value for the operation time and other risk factors in terms of the infection risk for flexible ureterorenoscopy. Int J Clin Pract, 2021, 75(4): e13846.
17. Calvo E, Torres MD, Morcillo D, et al. Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Arch Orthop Trauma Surg, 2019, 139(5): 669-674.
18. Carbone A, Poeran J, Zubizarreta N, et al. Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events. J Shoulder Elbow Surg, 2021, 30(1): 104-112.

West China Medical Journal

Clinical effectiveness and safety of tranexamic acid in arthroscopic rotator cuff repair: a meta-analysis

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