Perioperative hemorrhage during shoulder arthroscopy can lead to an unclear intraoperative field of view, prolonged operation time, associated postoperative shoulder swelling, bruising, and pain, and may increase the risk of infection. Therefore, minimizing perioperative bleeding during shoulder arthroscopy is crucial for reducing complications and speeding up postoperative recovery. Studies have reported that surgical trauma leads to increased fibrinolytic response, which accounts for 60% of the total perioperative blood loss in orthopedic surgery. In shoulder arthroscopic surgery bleeding in shoulder arthroscopic surgery can be reduced to a certain extent through delicate operation, anesthesia-controlled blood pressure reduction, and epinephrine perfusion. However, infiltration and bleeding of bones, muscles, and tissues are inevitable, so more surgeons further consider maintaining a balance between coagulation and fibrinolysis to reduce perioperative bleeding during shoulder arthroscopy. Tranexamic acid (TXA) is the most commonly used antifibrinolytic drug, which reversibly blocks the plasminogen's binding site, thereby preventing plasmin activation and reducing the degradation of plasmin to improve fibrin Clot stability. Many studies have shown that TXA can effectively minimize perioperative blood loss and blood transfusion rate in orthopedic surgery and does not increase the incidence of embolic events. In addition, studies have reported that TXA can regulate the immune system by blocking granules, thereby exerting anti-inflammatory effects. Therefore, in recent years, the clinical application of TXA in shoulder arthroscopic surgery has gradually increased. Liu et al. first reported the application of TXA in shoulder arthroscopic surgery. They found that intravenous injection of TXA can improve the clarity of field of view in shoulder arthroscopic surgery and reduce early postoperative pain and the number of analgesics without apparent side effects. Currently, there is a lack of clear consensus on using TXA in shoulder arthroscopic surgery. Objective A Meta-analysis of the literature was conducted to investigate the efficacy and safety of TXA for arthroscopic shoulder surgery.

We searched PubMed, Embase, Medline, Cochrane, Web of Science, CNKI, and WanFang databases until Nov 1, 2022, including randomized controlled trials and cohort studies, and supplemented relevant literature through traceability search. Meta-analysis was performed using RevMan5.4 statistical software.

Six studies were included in this meta-analysis, involving 437 patients, of which 218 were treated with TXA. Meta-analysis showed that patients in the TXA group had better visual clarity in arthroscopic shoulder surgery compared with the control group (SMD=0.38, 95%CI: 0.20, 0.57, P<0.00001), with a statistically significant. There was no statistically significant difference in the comparison of VAS score (SMD=-0.55, 95%CI: -1.21, 0.12, P=0.11), operative time (SMD=-9.83, 95%CI: -12.89, -6.78, P<0.01), irrigation amount used in operation (SMD=-2.10, 95%CI: -3.41, 0.79, P=0.002), and shoulder circumference (SMD=2.58, 95%CI: -2.63, 7.80, P=0.33). In the incidence of the embolic events (deep vein thrombosis, pulmonary embolism), there was no difference between groups between the TXA and control groups (RD=0, 95% CI: -0.02, 0.02, P=1.00) .

TXA is safe and effective in arthroscopic shoulder surgery, significantly improves intraoperative visual clarity, and does not increase the incidence of embolic events.