A Retrospective Study on the Role of Tranexamic Acid in Reverse Total Shoulder Arthroplasty for Trauma Patients With Complex Proximal Humerus Fractures

Background The role of tranexamic acid (TXA) in primary elective hip, knee, and shoulder arthroplasty is well established. This is a retrospective study, which explores the efficacy of TXA in proximal humerus fractures (PHF) requiring shoulder arthroplasty. Design and methods Patients undergoing reverse total shoulder arthroplasty (RSA) for PHF between January 2022 and May 2024 in Queen Elizabeth Hospital (QEH), Birmingham, UK were identified. Patients were administered 1 g of intravenous TXA injection preoperatively during anesthetics induction. The parameters reviewed included changes in hemoglobin (Hb) levels from preoperative to postoperative, postoperative blood transfusion rates, and length of hospital stay. Results Out of 78 patients, 35 (45%) patients received TXA whereas 43 (55%) patients did not receive TXA preoperatively. No significant drop in Hb levels from preoperative to postoperative was observed (TXA: 1.7 ± 1.2 g/dL vs. non-TXA: 2.0 ± 1.3 g/dL, P = 0.30). Seven out of 78 (8.9%) patients required blood transfusion (3 (TXA) vs. 4 (non-TXA); 6 (86%) females vs. 1 (14%) males). In the blood transfusion cohort, patients from both groups required a longer length of hospital stay postoperatively (TXA: 20.3 + 16.0 days vs. non-TXA: 18.5 ± 14.8 days, P = 0.88). Conclusion Intravenous 1 g of TXA preoperatively was not associated with a significant decrease in postoperative Hb reduction in trauma patients undergoing RSA for PHF. Females undergoing RSA are at a greater risk of blood transfusion despite TXA administration. Future studies should consider investigating the dose-dependent efficacy of intravenous TXA on Hb drop postoperatively on trauma patients undergoing RSA.