Tranexamic acid utilization remains low in anatomical and reverse total shoulder arthroplasty despite decreased postoperative complications: A propensity-matched analysis

Background: This study investigated the effect of tranexamic acid (TXA) on postoperative outcomes in anatomic total shoulder (aTSA) or reverse total shoulder arthroplasty (rTSA) surgery. Methods: We queried the TriNetX network for patients who underwent TSA from 2000 to 2025. Patients were 1:1 matched into aTSA or rTSA cohorts and subcategorized into TXA or non-TXA groups. Yearly trends in TXA utilization by TSA procedure were reported. Postoperative complications at 90 days and 2 years were assessed. Results: TXA utilization increased 7% in aTSA and 11% in rTSA from 2020 to 2024. Within 90 days, TXA patients in both cohorts had a reduced risk of transfusions, acute post-hemorrhagic anemia, and hospital readmission. TXA patients in the aTSA cohort had a reduced risk of pulmonary embolism within 90 days. At 2 years, TXA patients in both cohorts had a reduced risk of transfusions, surgical site infection, pulmonary embolism, and hospital readmission. TXA patients in the rTSA cohort had a higher risk of periprosthetic loosening at both follow-ups. Discussion: Patients receiving TXA had a significantly reduced risk of postoperative complications. TXA has a similar impact on outcomes in both TSA variations, and utilization should be considered as part of a comprehensive management strategy.