Mehmet ERSİN, Mehmet DEMİREL, Mehmet BUGET, İpek Saadet EDİPOĞLU, Ata Can ATALAR, Ali ERŞEN

The effect of intravenous tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A randomized, double-blinded, placebo-controlled pilot study

Objective: The aim of this study was to determine the effect of intravenous (IV) tranexamic acid (TRX) use on visual clarity during arthroscopic rotator cuff repair.Methods: This prospective, randomized, double-blinded, placebo-controlled study was conducted in patients scheduled for an arthroscopic rotator cuff repair. In total, 60 patients were randomly distributed into two groups: control (28 patients: 11 male, 17 female; mean age=53 years, age range=19-65) and TRX (32 patients: 15 male, 17 female; mean age=50, age range=18-69). In the TRX group, the arthroscopy was performed through the bolus IV administration of 10 mg/kg TRX in 100 ml isotonic saline solution. In the control group, the arthroscopy was performed through the bolus IV administration of 100 ml isotonic saline solution. In both the groups, the IV administration was carried out after the induction of anesthesia. At the end of each procedure, the surgeon rated the visual clarity on a scale from 1 to 10. In addition, operation time (minutes), irrigation amount used in operation (lt), and the need of pressure increase because of bleeding were recorded.Results: No adverse effects were seen during the study period. Visual clarity in TRX group was significantly better than the control group (the mean visual clarity scores=8.1/10 (range=7-10) vs 7/10 (range=5-9); p=0.018). The amount of solution was significantly less in the TRX group (10.2 lt (range=3.5-21)) than in the control group (15.8 lt (range=5.8-27); p=0.007, post-hoc power=95.7%), although the operation time was slightly longer in the TRX group (106 minutes (range=50-210)) than in the control group (99 minutes (range=45-165); p=0.24). Moreover, the need for the increase in pressure owing to bleeding was found significantly less in the TRX group (5.8 times (range=(0-9)) than in the control group (9.6 times (range=0-13); p=0.04, post-hoc power=94.5%).Conclusion: Preoperative IV TRX administration seems to be effective in improving visual clarity and reducing the need for high pressure and the amount of irrigation fluid during the arthroscopic rotator cuff repair.

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1. van Montfoort DO, van Kampen PM, Huijsmans PE. Epinephrine diluted saline-irrigation fluid in arthroscopic shoulder surgery: A significant improvement of clarity of visual field and shortening of total operation time. A randomized controlled trial. Arthroscopy 2016; 32: 436-44. [Crossref]

2. Avery DM 3rd, Gibson BW, Carolan GF. Surgeon-rated visualization in shoulder arthroscopy: A randomized blinded controlled trial comparing irrigation fluid with and without epinephrine. Arthroscopy 2015; 31: 12-8. [Crossref]

3. Akgül T, Büget M, Salduz A, et al. Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study. Acta Orthop Traumatol Turc 2016; 50: 429-31. [Crossref]

4. Kim C, Park SS-H, Davey JR. Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage: Current evidence. J Blood Med 2015; 6: 239-44. [Crossref]

5. Gillespie R, Shishani Y, Joseph S, Streit JJ, Gobezie R. Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24: 1679-84. [Crossref]

6. Vara AD, Koueiter DM, Pinkas DE, Gowda A, Wiater BP, Wiater JM. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: A prospective, double-blinded, randomized, controlled trial. J Shoulder Elbow Surg 2017; 26: 1383-9. [Crossref]

7. Huang Z, Xie X, Li L, et al. Intravenous and topical tranexamic acid alone are superior to tourniquet use for primary total knee arthroplasty: A prospective, randomized controlled trial. J Bone Joint Surg Am 2017; 99: 2053-61. [Crossref]

8. Zufferey PJ, Ollier E, Hodin S, Delavenne X, PeriOpeRative Tranexamic acid in hip arthrOplasty (PORTO) study investigators. Is tranexamic acid exposure related to blood loss in hip arthroplasty? A pharmacokinetic-pharmacodynamic study. Br J Clin Pharmacol 2018; 84: 310-9. [Crossref]

9. Karaaslan F, Karaoğlu S, Yurdakul E. reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid: A prospective, randomized controlled trial. Am J Sports Med 2015; 43: 2720-6. [Crossref]