*Article* **Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis**

**Jaroslaw Pecold 1,2, Mahdi Al-Jeabory 1,2, Maciej Krupowies 2, Ewa Manka 3, Adam Smereka 4, Jerzy Robert Ladny 2,5 and Lukasz Szarpak 2,6,7,\***


**Abstract:** Tranexamic acid (TXA) is an antifibrinolytic agen<sup>t</sup> that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and metaanalysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; *p* < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; *p* < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; *p* < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

**Keywords:** tranexamic acid; TXA; shoulder; arthroscopy; bleeding; systematic review; meta-analysis
