The efficacy of preoperative tranexamic acid administration among patients undergoing arthroscopic rotator cuff repair: A systematic review and meta-analysis of randomized controlled trials

Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of tranexamic acid (TXA) among patients undergoing arthroscopic rotator cuff repair (ARCR).Methods Five databases were screened until December 18, 2022. The included RCTs were assessed for risk of bias, and the endpoints were summarized as mean difference/standardized mean difference (MD/SMD) or risk ratio (RR) with the 95% confidence interval (CI) in a random-effects model.Results Seven RCTs with 510 patients (TXA = 261 and control/placebo = 249) were analyzed. The overall risk of bias was "low" and "unclear" in four and three RCTs, respectively. The mean operative time (n = 5 RCTs, MD = -9.64 min, 95% CI [-15.74, -3.54], p = 0.002) and mean postoperative pain score on postoperative day 1 (n = 5 RCTs, MD = -0.56, 95% CI [-1.06, -0.05], p = 0.03) were significantly reduced in the TXA group compared with the control group. However, there were no significant differences between both groups regarding visual clarity, amount of irrigation solution, and estimated intraoperative blood loss.Conclusion Among patients undergoing ARCR, preoperative TXA did not reduce intraoperative blood loss or improve visual clarity. However, TXA administration correlated with significant reductions (statistically) in operative time and postoperative day 1 pain score compared with the control group. Level of evidence: Level I; Systematic Review and Meta-analysis of Randomized Controlled TrialsConclusion Among patients undergoing ARCR, preoperative TXA did not reduce intraoperative blood loss or improve visual clarity. However, TXA administration correlated with significant reductions (statistically) in operative time and postoperative day 1 pain score compared with the control group. Level of evidence: Level I; Systematic Review and Meta-analysis of Randomized Controlled Trials