Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia?

Kang, Hyeon Hui; Hwang, Se Hwan

doi:10.1016/j.bjorl.2019.08.006

Cited by 21 publications

(20 citation statements)

References 24 publications

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“…According to the four included articles, different routes of administration had a similar hemostatic effect, and both oral and IV TXA were reliable in short-term surgical results and for thromboembolic complications ( de Vasconcellos et al, 2018 ; Kim et al, 2019 ; Kang and Hwang, 2020 ). Due to the narrow scope of surgery in the nasal cavity, slight bleeding could distort the vision of the endoscope.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the narrow scope of surgery in the nasal cavity, slight bleeding could distort the vision of the endoscope. TXA reduced intraoperative blood loss and improved the quality of the surgical field in endoscopic sinus surgery, thereby increasing the surgeon’s satisfaction and the success rate of the operation ( Kim et al, 2019 ; Kang and Hwang, 2020 ). However, de Vasconcellos et al (2018) reported that giving oral TXA (1 g) (WMD -61.70, 95% CI, –83.02 to –40.39) 2 h before rhinoplasty surgery reduced more intraoperative bleeding than IV TXA (10 mg/kg) (WMD –23.88, 95% CI, –45.19 to –2.58).…”

Section: Discussionmentioning

confidence: 99%

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Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

et al. 2022

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Background: Tranexamic acid (TXA) has been applied in various types of surgery for hemostasis purposes. The efficacy and safety of TXA are still controversial in different surgeries. Guidelines for clinical application of TXA are needed.Materials and method: We systematically searched multiple medical databases for meta-analyses examining the efficacy and safety of TXA. Types of surgery included joint replacement surgery, other orthopedic surgeries, cardiac surgery, cerebral surgery, etc. Outcomes were blood loss, blood transfusion, adverse events, re-operation rate, operative time and length of hospital stay, hemoglobin (Hb) level, and coagulation function. Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used for quality assessment of the included meta-analyses. Overlapping reviews were evaluated by calculating the corrected covered area (CCA).Result: In all, we identified 47 meta-analyses, of which 44 of them were of “high” quality. A total of 319 outcomes were evaluated, in which 58 outcomes were assessed as “high” quality. TXA demonstrates significant hemostatic effects in various surgeries, with lower rates of blood transfusion and re-operation, shorter operative time and length of stay, and higher Hb levels. Besides, TXA does not increase the risk of death and vascular adverse events, but it is a risk factor for seizure (a neurological event) in cardiac surgery.Conclusion: Our study demonstrates that TXA has a general hemostatic effect with very few adverse events, which indicates TXA is the recommended medication to prevent excessive bleeding and reduce the blood transfusion rate. We also recommend different dosages of TXA for different types of adult surgery. However, we could not recommend a unified dosage for different surgeries due to the heterogeneity of the experimental design.Systematic Review Registration:clinicaltrials.gov/, identifier CRD42021240303

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

et al. 2022

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“…The mean hemoglobin drop was even double in one of the studies when TA was not administered another important factor in evaluation of the blood loss, was much higher in groups not receiving TA. All included studies [5] ] showed less significant results. In addition, the included studies revealed that bleeding complications such as hematuria, blood transfusion, angioembolization, or hypovolemic shock could be reduced by the use of TA (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TA) is a synthetic lysine analogue used to treat or prevent severe blood loss. TA provides anti-fibrinolytic, hemostatic, anti-allergic, and anti-inflammatory effects [3] and is very effective in bleeding conditions such as hypermenorrhea, functional uterine bleeding [4], severe bleeding during surgery [5], acute epistaxis [6], upper gastrointestinal bleeding [7], and in the treatment of inflammatory diseases [8]. Previous studies showed that tranexamic acid could be used peri-operatively for reducing the incidence of bleeding in patients undergoing PCNL.…”

Section: Introductionmentioning

confidence: 99%

Is There Any Clinical Benefit for Peri-operative Administration of Tranexamic Acid for Patients Undergoing Percutaneous Nephrolithotomy? A Systematic Review and Meta-analysis

et al. 2021

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Purpose of ReviewThe purpose of current systematic review and meta-analysis is to determine the efficacy and safety of the administration of tranexamic acid in patients undergoing PCNL. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. This systematic review and meta-analysis includes randomized comparative prospective studies. Recent Findings The primary endpoints were the hemoglobin drop, the bleeding complications, and the transfusion rate. Secondary endpoints included the operative time, the stone-free rate, the hospital stay, and the overall complications. Two-thousand five-hundred six publications were screened for this study. Six RCTs (1262 patients) were included in the metaanalysis. As for our primary endpoints, the hemoglobin drop was lower in the tranexamic group than in the control group, with mean difference (MD) of − 0.65 (p < 0.0001); the bleeding complications were rarer in the tranexamic group than in the control group, with an odds ratio (OR) of 0.32 (p < 0.00001); and the transfusion rate was lower in the tranexamic group with an OR of 0.34 (p = 0.0007). Concerning the secondary endpoints, the operative time was less in the tranexamic group with an MD of − 10.39 (p < 0.0001), the meta-analysis of the stone-free status data showed no statistical significance between the two groups with an OR of 1.58 (p = 0.09), the hospital stay was significantly less in the tranexamic group with an MD of − 1.38 (p = 0.005), and the overall complications were rarer in the tranexamic group than in the control group with an OR of 0.34 (p = 0.12). Summary The peri-operative use of TA contributes to the reduction of blood loss, bleeding complications, mean operative time, and hospital stay. The use of TA seemed to be safe and well tolerated in patients undergoing PCNL. PROSPERO protocol (Registration number: CRD42019122818)

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“…Kang et al recently performed a review on the use of topical TXA to reduce intraoperative bleeding in sinus surgery. 47 Meta-analysis demonstrated an overall statistically significant reduction in intraoperative bleeding with topical TXA and significantly improved surgical fields. Additionally, no change in haemodynamics was demonstrated.…”

Section: Sinus Surgerymentioning

confidence: 94%

Tranexamic acid in otorhinolaryngology – A contemporary review

Fuzi

Budiono

Meller

et al. 2021

World j. otorhinolaryngol.-head neck surg.

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Tranexamic acid (TXA) is an anti‐fibrinolytic agent which has been proven beneficial in multiple surgical specialties where significant bleeding can occur. Whilst it has been widely available for over 40 years its use within Otorhinolaryngology is still limited. Operations in Otorhinolaryngology are particularly varied with some such as tonsillectomy having the potential for significant life threatening bleeding. Other operations are performed within small confined surgical fields and even small amounts of bleeding can significantly detriment surgical field and increase technical difficulty and operative time. This review evaluated the current literature on the benefits of tranexamic acid within the field of Otorhinolaryngology and Head and Neck Surgery. Overall TXA was demonstrated to be a safe drug with no major adverse effects including thromboembolic events reported in any study. It has been shown to be of particular benefit in rhinology by improving surgical field, reducing operative time and reducing postoperative swelling and ecchymosis. The benefit in tonsillectomy is less clear and further studies are required to evaluate its potential use in the reduction of post tonsillectomy haemorrhage rates.

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Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia?

Cited by 21 publications

References 24 publications

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

Is There Any Clinical Benefit for Peri-operative Administration of Tranexamic Acid for Patients Undergoing Percutaneous Nephrolithotomy? A Systematic Review and Meta-analysis

Tranexamic acid in otorhinolaryngology – A contemporary review

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