Intravenous tranexamic acid versus topical thrombin in shoulder arthroplasty.
BACKGROUND: Blood loss and transfusions have been highlighted as a significant predictor of postoperative morbidity. Tranexamic acid has been shown to decrease blood loss and transfusion in shoulder arthroplasty. However, the utility of topical thrombin in total shoulder arthroplasty is unknown. The purpose of this study is to assess the utility of topical thrombin in TSA, and compare the effectiveness of topical thrombin to intravenous tranexamic acid. METHODS: An institutional database was used to query shoulder arthroplasty patients from January 2017 to July 2019. Patients undergoing shoulder arthroplasty (TSA) were identified with CPT code (23742). After excluding RSA, arthroplasty for fracture or revision, the study groups were stratified based on intervention with IV TXA, topical thrombin or neither. Patient demographics, ASA, baseline coagulopathy, preoperative and postoperative hemoglobin, operative time, transfusion, length of stay (LOS) and 90-day readmission for each treatment group was obtained. RESULTS: 283 TSA cases were included for final analysis. There was no statistically significant difference in the baseline characteristics with age, BMI or ASA. Postoperative Hgb (mg/dL) was higher in the group that received either IV TXA or thrombin compared to no hemostatic agents (p=0.001). Calculated blood loss in TSA was significantly higher in the group without hemostatic agents, 369.8 ml (59.5 SD) compared to IV TXA or topical thrombin, 344.3 ml (67.1 SD) and 342.9 ml (65.6 SD) (p=0.03). Operative time was highest in the group that received no hemostatic agents, 2.3 hours (0.6 SD) (p=0.01). Transfusion rate for TSA treated with IV TXA or topical thrombin was equivalent (2.2%) but significantly lower than no intervention group (12%) (p=0.01). Odd's ratio for transfusion with IV TXA was 0.16 (95% CI 0.07-0.40, p = 0.001), and topical thrombin was 0.1 (95% CI 0.02-0.42, p = 0.02). CONCLUSION: Topical thrombin is an effective adjunct to reduce blood loss and transfusion risk after total shoulder arthroplasty (TSA) and a reasonable intraoperative alternative for TXA for patients with contraindication to IV TXA. LEVEL OF EVIDENCE: Level III; Retrospective Cohort Comparison; Treatment Study.
Belay, ES; O'Donnell, J; Flamant, E; Hinton, Z; Klifto, CS; Anakwenze, O
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