**1. Introduction**

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> Tranexamic acid (TXA) is an antifibrinolytic that inhibits fibrin's plasmin-mediated degradation and is used to stabilize clots and reduce active bleeding. In orthopaedic surgery, tranexamic acid is most notably involved in the elective orthopaedic procedures necessitating transfusion [1,2]. The use of tranexamic acid has become widely accepted in total knee and hip arthroplasty to prevent extensive blood loss and lower transfusion rates, but it can be also beneficial for patients who undergo total shoulder arthroplasty [3]. A significant benefit of TXA in several types of orthopaedic surgery may also be a reduction in the need for blood product transfusions, reduced hospital costs, laboratory costs and shorter hospital stays [3]. When considering the benefits of TXA, it is also essential to consider the risk for increased thromboembolic events and provide post-operative thromboprophylaxis [4].

> Shoulder-scapular-joint alloplasty procedures have become increasingly popular in recent years. Modern implants provide various surgical options, depending on the indications and anatomical conditions. Although the number of possible complications is still

**Citation:** Pecold, J.; Al-Jeabory, M.; Krupowies, M.; Manka, E.; Smereka, A.; Ladny, J.R.; Szarpak, L. Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. *J. Clin. Med.* **2022**, *11*, 48. https://doi.org/10.3390/ jcm11010048

Academic Editors: Markus Scheibel, Alexandre Lädermann and Laurent Audigé

Received: 8 December 2021 Accepted: 23 December 2021 Published: 23 December 2021

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high, the results of revision surgery are improving [5]. Shoulder alloplasty can be divided into the partial and total shoulder [5]. Total shoulder arthroplasty is divided into anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) [6]. One method used to improve the procedure's effectiveness and reduce possible bleeding complications and the need for blood transfusions is the perioperative use of tranexamic acid [7]. Importantly, perioperative use of TXA does not appear to significantly increase the risk of incident embolic and thrombotic events [8], including patients with a history of similar incidents [9]. Additionally, perioperative use of tranexamic acid at a dose of 20 mg/kg body weight shortens the recovery time of patients and contributes to shorter hospitalizations [10].

We already know that TXA reduces blood loss in shoulder arthroplasty, but the benefits and risks of using tranexamic acid are still unclear. Meta-analysis of data from different studies may facilitate clinical decision-making regarding the use of TXA, including support for accurate assessment of some rare complications and their clinical significance.

Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid of the shoulder arthroplasty.

#### **2. Materials and Methods**
