Tranexamic Acid Has A Limited Role in Improving Visual Clarity and Pain in Arthroscopic Shoulder Surgery: A Systematic Review and Meta-Analysis.

Purpose: The purpose of this systematic review was to evaluate the effects of tranexamic acid (TXA) compared to placebo or other comparators with regard to visual clarity, pain, total operative time, and volume of blood loss in patients undergoing arthroscopic shoulder surgery.

Methods: CENTRAL, EMBASE, and MEDLINE were searched from inception until January 4th, 2025. Study selection and data extraction were carried out in duplicate. Randomized controlled trials that compared TXA versus placebo or another comparator in patients undergoing arthroscopic shoulder surgery were included. All outcomes were assessed in duplicate for risk of bias (RoB) using the RoB-2 tool and for certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results were pooled in a meta-analysis using a random-effects model when appropriate or were synthesized narratively when data could not be pooled.

Results: Overall, 12 randomized controlled trials involving 1009 patients were included. The pooled estimate for visual clarity shows a slight increase in visual clarity (Standardized Mean Difference 0.64 [0.05, 1.24]). The pooled estimate for pain shows a mean difference of a reduction of pain by 0.38 points in the TXA group on a visual analog scale of 0 to 10 (0 = no pain) (Mean Difference -0.38 [-0.76, 0.00]).

Conclusions: There is moderate-certainty evidence suggesting that TXA likely results in a slight increase in visual clarity. The evidence also suggests that TXA has little to no difference in pain, operative time, and volume of blood loss.

Level of evidence: Level I, systematic review of Level I studies.