Tranexamic acid utilization remains low in anatomical and reverse total shoulder arthroplasty despite decreased postoperative complications: A propensity-matched analysis

Background This study investigated the effect of tranexamic acid (TXA) on postoperative outcomes in anatomic total shoulder (aTSA) or reverse total shoulder arthroplasty (rTSA) surgery. Methods We queried the TriNetX network for patients who underwent TSA from 2000 to 2025. Patients were 1:1 matched into aTSA or rTSA cohorts and subcategorized into TXA or non-TXA groups. Yearly trends in TXA utilization by TSA procedure were reported. Postoperative complications at 90 days and 2 years were assessed. Results TXA utilization increased 7% in aTSA and 11% in rTSA from 2020 to 2024. Within 90 days, TXA patients in both cohorts had a reduced risk of transfusions, acute post-hemorrhagic anemia, and hospital readmission. TXA patients in the aTSA cohort had a reduced risk of pulmonary embolism within 90 days. At 2 years, TXA patients in both cohorts had a reduced risk of transfusions, surgical site infection, pulmonary embolism, and hospital readmission. TXA patients in the rTSA cohort had a higher risk of periprosthetic loosening at both follow-ups. Discussion Patients receiving TXA had a significantly reduced risk of postoperative complications. TXA has a similar impact on outcomes in both TSA variations, and utilization should be considered as part of a comprehensive management strategy.