Does Tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

AbstractBackground/ObjectiveEffective hemostasis has the potential to reduce inflammation and pain, leading to potential benefits in the early rehabilitation of patients who undergo elbow arthrolysis. In the present study, we aim to assesse the effects of tranexamic acid (TXA) on elbow arthrolysis postoperative blood loss, patients' pain perception according to the visual analog scale (VAS), elbow range of motion (ROM), and complications.MethodsWe systematically searched PubMed, Web of Science, SCOPUS, and Cochrane Library for studies comparing blood loss between intravenous (IV) TXA and placebo/no treatment. One randomized clinical trial, and three non-randomized clinical trial studies met eligibility criteria.ResultsThe meta-analysis determined that tranexamic acid application reduced drain output 34mm on average (WMD: -34.00 (95% CI: -49.45, -18.55). There was a discrepancy among included articles in terms of intra-operative blood loss; although the study with the largest sample size (291 and 296 patients in the case and control groups, respectively) reported reduced intra-operative blood loss in patients who received TXA. Results for pain intensity, ROM, and complications such as hematoma and ulnar nerve palsy were inconsistent.ConclusionTXA may be beneficial to reduce elbow arthrolysis bleeding volume. However, it dose not seem to affect final elbow ROM and patients’ pain score. Further high-quality clinical trials are needed to draw a robust conclusion on this topic.Level of evidence:level I (systematic review and meta analysis)