Intravenous tranexamic acid shows limited efficacy in arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized-controlled trials

Purpose: The use of intravenous (IV) tranexamic acid (TXA) in arthroscopic shoulder surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of IV TXA in improving perioperative outcomes during shoulder arthroscopy. Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to February 2025. Randomized-controlled trials (RCTs) comparing IV TXA with group without TXA in patients undergoing arthroscopic shoulder surgery were included. Data were synthesized using random-effects models, with results presented as weighted mean differences (WMDs) and standardized mean differences (SMDs), with 95% confidence intervals (CIs). Results: Eleven RCTs involving 904 patients were included. Overall, seven trials were rated as high quality, while four trials were rated as moderate quality. Pooled results showed no statistically differences between TXA and control groups in terms of visual clarity (SMD: 0.25, 95% CI: -0.21 to 0.70), visual analog scale score (WMD: -0.33, 95% CI: -0.76 to 0.10), operative time (WMD: -4.48 min, 95% CI: -10.25 to 1.28), irrigation volume (SMD: -0.14, 95% CI: -0.52 to 0.24), estimated blood loss (SMD: -0.62, 95% CI: -1.86 to 0.61), and mean arterial pressure (WMD: -0.10 mmHg, 95% CI: -3.05 to 2.86). No complications were reported in either group across six studies. Conclusions: Current evidence does not support a significant clinical benefit of IV TXA in arthroscopic shoulder surgery. Further high-quality RCTs are needed to clarify its role under standardized protocols.