TY - JOUR
T1 - Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events
AU - Carbone, Andrew
AU - Poeran, Jashvant
AU - Zubizarreta, Nicole
AU - Chan, Jimmy
AU - Mazumdar, Madhu
AU - Parsons, Bradford O.
AU - Galatz, Leesa M.
AU - Cagle, Paul J.
N1 - Publisher Copyright:
© 2020 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2021/1
Y1 - 2021/1
N2 - Introduction: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion risk in various orthopedic surgeries including shoulder arthroplasty. However, concerns still exist regarding its use in patients with a history of thrombotic events. Using national claims data, we aimed to study the safety of TXA administration in shoulder arthroplasty patients with a history of thrombotic events. Methods: We used retrospective national claims data (Premier Healthcare) on 71,174 patients who underwent a total or reverse shoulder arthroplasty between 2010 and 2016. TXA use was evaluated specifically within a subgroup of patients with a history of thrombotic events such as myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke. Studied outcomes were blood transfusion need, complications (including acute renal failure, new onset myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke), and cost and length of hospitalization. Mixed-effects models measured the association between TXA use and outcomes, separately in patients with and without a history of thrombotic events. Odds ratios (OR) or percent change for continuous outcomes with 95% confidence intervals (CI) were reported. Results: Overall, TXA was used in 13.7% (n = 9735) of patients, whereas 10.5% (n = 7475) of patients had a history of a thrombotic event. After adjustment for relevant covariates, TXA use (compared with no TXA use) in patients without a history of thrombotic events was associated with decreased odds of blood transfusions (OR, 0.48; CI, 0.24-0.98; P =.0444), whereas no increased odds for complications were observed (OR, 0.83; CI, 0.40-1.76; P =.6354). Similar results were observed in patients with a history of thrombotic events. Moreover, in this subgroup, TXA use was associated with a slight reduction in hospitalization cost (−8.9% CI: −13.1%; −4.6%; P <.0001; group median $18,830). Conclusions: Among shoulder arthroplasty patients, TXA use was not associated with increased complication odds, independent of a history of thrombotic events. These findings are in support of wider TXA use.
AB - Introduction: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion risk in various orthopedic surgeries including shoulder arthroplasty. However, concerns still exist regarding its use in patients with a history of thrombotic events. Using national claims data, we aimed to study the safety of TXA administration in shoulder arthroplasty patients with a history of thrombotic events. Methods: We used retrospective national claims data (Premier Healthcare) on 71,174 patients who underwent a total or reverse shoulder arthroplasty between 2010 and 2016. TXA use was evaluated specifically within a subgroup of patients with a history of thrombotic events such as myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke. Studied outcomes were blood transfusion need, complications (including acute renal failure, new onset myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke), and cost and length of hospitalization. Mixed-effects models measured the association between TXA use and outcomes, separately in patients with and without a history of thrombotic events. Odds ratios (OR) or percent change for continuous outcomes with 95% confidence intervals (CI) were reported. Results: Overall, TXA was used in 13.7% (n = 9735) of patients, whereas 10.5% (n = 7475) of patients had a history of a thrombotic event. After adjustment for relevant covariates, TXA use (compared with no TXA use) in patients without a history of thrombotic events was associated with decreased odds of blood transfusions (OR, 0.48; CI, 0.24-0.98; P =.0444), whereas no increased odds for complications were observed (OR, 0.83; CI, 0.40-1.76; P =.6354). Similar results were observed in patients with a history of thrombotic events. Moreover, in this subgroup, TXA use was associated with a slight reduction in hospitalization cost (−8.9% CI: −13.1%; −4.6%; P <.0001; group median $18,830). Conclusions: Among shoulder arthroplasty patients, TXA use was not associated with increased complication odds, independent of a history of thrombotic events. These findings are in support of wider TXA use.
KW - Level III
KW - Retrospective Cohort Comparison Using Large Database
KW - Tranexamic acid
KW - Treatment Study
KW - complications
KW - high-risk patients
KW - myocardial infarction
KW - pulmonary embolus
KW - shoulder arthroplasty
KW - stroke
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=85089358280&partnerID=8YFLogxK
U2 - 10.1016/j.jse.2020.04.050
DO - 10.1016/j.jse.2020.04.050
M3 - Article
C2 - 32807373
AN - SCOPUS:85089358280
SN - 1058-2746
VL - 30
SP - 104
EP - 112
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 1
ER -