{"title":"Tranexamic Acid Has a Limited Role in Improving Visual Clarity and Pain in Arthroscopic Shoulder Surgery: A Systematic Review and Meta-Analysis","authors":"Danielle Dagher M.Sc. , Imad Kashir M.Sc. , Osman Mahboob B.S. , Nasser Al-Turki M.D. , Moin Khan M.D., M.Sc., F.R.C.S.C.","doi":"10.1016/j.arthro.2025.03.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effects of tranexamic acid (TXA) compared with placebo or other comparators regarding visual clarity, pain, total operative time, and volume of blood loss in patients undergoing arthroscopic shoulder surgery.</div></div><div><h3>Methods</h3><div>CENTRAL, EMBASE, and MEDLINE were searched from inception until January 4, 2025. Study selection and data extraction were carried out in duplicate. Randomized controlled trials that compared TXA with placebo or another comparator in patients undergoing arthroscopic shoulder surgery were included. All outcomes were assessed in duplicate for risk of bias (RoB) using the RoB 2 tool and for certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results were pooled in a meta-analysis using a random-effects model when appropriate or were synthesized narratively when data could not be pooled. Overall, 12 randomized controlled trials involving 1,009 patients were included.</div></div><div><h3>Results</h3><div>The pooled estimate for visual clarity shows a slight increase in visual clarity (standardized mean difference 0.64 [0.05, 1.24]). The pooled estimate for pain shows a mean difference of a reduction of pain by 0.38 points in the TXA group on a visual analog scale of 0 to 10 (0 = no pain) (mean difference -0.38 [-0.76, 0.00]).</div></div><div><h3>Conclusions</h3><div>There is moderate-certainty evidence suggesting that TXA likely results in a slight increase in visual clarity. The evidence also suggests that TXA has little to no difference in pain, operative time, and volume of blood loss.</div></div><div><h3>Level of Evidence</h3><div>Level I, Systematic Review of Level I Studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 10","pages":"Pages 4264-4274.e1"},"PeriodicalIF":5.4000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0749806325001641","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose
To evaluate the effects of tranexamic acid (TXA) compared with placebo or other comparators regarding visual clarity, pain, total operative time, and volume of blood loss in patients undergoing arthroscopic shoulder surgery.
Methods
CENTRAL, EMBASE, and MEDLINE were searched from inception until January 4, 2025. Study selection and data extraction were carried out in duplicate. Randomized controlled trials that compared TXA with placebo or another comparator in patients undergoing arthroscopic shoulder surgery were included. All outcomes were assessed in duplicate for risk of bias (RoB) using the RoB 2 tool and for certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results were pooled in a meta-analysis using a random-effects model when appropriate or were synthesized narratively when data could not be pooled. Overall, 12 randomized controlled trials involving 1,009 patients were included.
Results
The pooled estimate for visual clarity shows a slight increase in visual clarity (standardized mean difference 0.64 [0.05, 1.24]). The pooled estimate for pain shows a mean difference of a reduction of pain by 0.38 points in the TXA group on a visual analog scale of 0 to 10 (0 = no pain) (mean difference -0.38 [-0.76, 0.00]).
Conclusions
There is moderate-certainty evidence suggesting that TXA likely results in a slight increase in visual clarity. The evidence also suggests that TXA has little to no difference in pain, operative time, and volume of blood loss.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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