Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty

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118 patients undergoing primary total shoulder arthroplasty (TSA) or total reverse shoulder arthroplasty (TRSA) for treatment of degenerative joint disease were randomized to a group receiving topical application of tranexamic acid (TXA) during surgery, or to a control group. The purpose of the study was to evaluate the efficacy of TXA in shoulder arthroplasty in terms of post-operative blood loss and hemoglobin level reduction. Tranexamic acid was found to significantly reduce post-operative blood loss and degree of hemoglobin loss compared to the control. In subgroup analysis of TSA patients, tranexamic acid significantly reduced post-operative blood loss but did not affect hemoglobin loss. In TRSA patients, difference in post-operative blood loss was insignificant between groups but the tranexamic acid group had significantly less hemoglobin loss. No blood transfusions or complications were noted in either group.