Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty

Vasconcellos, Sara de Abreu de Juliana; Nascimento-Júnior, Edmundo Marques do; Menezes, Marcel Vinicius de Aguiar; Mendes, Mário Luis Tavares; Dantas, Rafael de Souza; Martins-Filho, Paulo Ricardo

doi:10.1001/jamaoto.2018.1381

Cited by 53 publications

(41 citation statements)

References 73 publications

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“…The major clinical benefits of TXA use in plastic surgery are generally the same as in other surgical subspecialties; reduced blood loss and, possibly, hematoma formation. However, the gained anti-inflammatory benefit adds significant appeal for plastic surgeons, especially for cosmetic procedures [9,75]. Given the limited number of clinical studies, additional prospective trials are warranted to study these effects.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

et al. 2021

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Background Excessive blood loss, during or after surgery, remains a major surgical concern despite the continuous improvement of surgical standards. Tranexamic acid (TXA), an anti-fibrinolytic, is a potential agent that has been used in a variety of methods to mitigate blood loss. In addition, TXA shows additional anti-inflammatory effects which may be of particular interest. The objective of this study is to review clinical studies involving the use of TXA in plastic surgery related procedures. Methods We carried out a literature search of Google Scholar, PubMed, Ovid Medline, and Cochrane databases since their inception for relevant clinical studies on TXA use (dosages/routes of administration) in plastic surgery-related procedures. Results Forty-five articles were included in this review. These included studies assessing the use of TXA in craniofacial surgery (15 studies), aesthetic and breast-related surgeries (23 studies), burn care (4 studies), and microsurgery (3 studies). For each subset, study design, study sample size, surgical procedure performed, TXA route of administration, dosage, study outcomes, and adverse events were summarized and reported in a separate section. Conclusions TXA is widely studied in the field of craniofacial surgery, specifically craniosynostosis surgery. Intravenous administration of TXA is the most commonly studied route of administration. Topical formulations seem to be on the rise and the added local anti-inflammatory effects and safety profile of topical use add significant appeal. Moreover, evidence on appropriate dosage protocols is scarce. The variable approach in dosing warrants further trials to assess the clinical implications, as well as potential benefit in using TXA more efficiently in the field of plastic surgery, as a whole. Level of evidence: Not ratable

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Section: Discussionmentioning

confidence: 99%

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

et al. 2021

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“…[9] Conducting a systematic review in 2018, De Vasconcellos et al investigated the effect of TA on the amount of BL during rhinoplasty surgery and according to the results of this study, BL during surgery in the TA-receiving group was significantly less than the control group, which is consistent with the results of the present study. [10] In a study conducted by Kalkarni et al in 2016 on 240 patients undergoing head and neck cancer surgeries, one group of patients was injected with 10 cc/kg of diluted TA before surgery and the other group was injected with the same amount of normal saline. According to the results, there was no significant difference between the two groups in terms of BL during surgery, but there was a significant difference between the TA-receiving group and the control group regarding the amount of BL over 24 h after surgery, both results inconsistent with the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

Can Tranexamic Acid Control Bleeding during and After Total Thyroidectomy? A Randomized Double-blind Clinical Trial Study

Alipour¹,

Jafari²,

Dashti³

et al. 2020

Clin J Surg

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Introduction: Head and neck operations are among the thyroid surgeries which are occasionally accompanied by blood loss (BL) during operation, tainting the operating field, and increasing the probability of damage to adjacent structures. Several studies have hitherto been conducted toward decreasing the BL that occurs during and after the operation. This study has been designed and executed with the objective of determining and comparing the effectiveness of tranexamic acid (TA) medication on controlling BL during and after total thyroidectomy. Materials and Methods: This study was carried out as a double-blind clinical trial on 83 patients affected with benign and malignant pathologies which were candidates for total thyroidectomy surgical operation, referred to the surgery department of Shahid Rahnemoun Hospital in Yazd, Iran, during a 1-year period. Patients were randomly divided into two groups including TA recipients, for which 20 mg/kg of TA was diluted to 20 cc with normal saline before surgery, and the control group which did not receive TA. The amount of BL during surgery was measured based on the blood gas value at the time of operation and post-surgery BL was measured based on the amount of blood collected in the Hemovac drain. The patients' hemoglobin was also measured and recorded before surgery and 24 h after surgery. Results: Among the 83 studied patients, 42 patients received TA, whereas the other 41 did not receive this medication. BL during surgery in the TA receiving group was significantly less than the control group (P = 0.016). Post-operation BL in the TA receiving group was also less than the control group, although the difference was not statistically significant (P = 0.5). Moreover, the decline of hemoglobin level 24 h after surgery was not significant in the TA receiving group and the control group. Conclusion: According to the results of the present study, TA significantly reduces the amount of BL during the surgical procedure of total thyroidectomy. TA also results in a non-significant reduction of post-operation BL, whereas the hemoglobin level is not affected by it.

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“…However, there are contradictory results and most studies that investigated (adeno)tonsillectomy were performed before 1980, and future well-designed randomized controlled trials may shed new light on the findings. For rhinoplasty, a meta-analysis including 276 patients indicated that TXA, 10 mg/kg intravenous or 1 g orally prior to surgery, possibly followed by 1 g 3x/day postoperatively for a maximum of 5 days (Table 1 ), resulted in a significant reduction of intraoperative bleeding (as well as postoperative eyelid edema and ecchymosis) [ 46 ]. There are no data available regarding the thromboembolic events [ 46 ].…”

Section: Maintextmentioning

confidence: 99%

“…For rhinoplasty, a meta-analysis including 276 patients indicated that TXA, 10 mg/kg intravenous or 1 g orally prior to surgery, possibly followed by 1 g 3x/day postoperatively for a maximum of 5 days (Table 1 ), resulted in a significant reduction of intraoperative bleeding (as well as postoperative eyelid edema and ecchymosis) [ 46 ]. There are no data available regarding the thromboembolic events [ 46 ].…”

Section: Maintextmentioning

confidence: 99%

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

et al. 2021

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Objectives We review the evidence for tranexamic acid (TXA) for the treatment and prevention of bleeding caused by surgery, trauma and bleeding disorders. We highlight therapeutic areas where evidence is lacking and discuss safety issues, particularly the concern regarding thrombotic complications. Methods An electronic search was performed in PubMed and the Cochrane Library to identify clinical trials, safety reports and review articles. Findings TXA reduces bleeding in patients with menorrhagia, and in patients undergoing caesarian section, myomectomy, hysterectomy, orthopedic surgery, cardiac surgery, orthognathic surgery, rhinoplasty, and prostate surgery. For dental extractions in patients with bleeding disorders or taking antithrombotic drugs, as well as in cases of idiopathic epistaxis, tonsillectomy, liver transplantation and resection, nephrolithotomy, skin cancer surgery, burn wounds and skin grafting, there is moderate evidence that TXA is effective for reducing bleeding. TXA was not effective in reducing bleeding in traumatic brain injury and upper and lower gastrointestinal bleeding. TXA reduces mortality in patients suffering from trauma and postpartum hemorrhage. For many of these indications, there is no consensus about the optimal TXA dose. With certain dosages and with certain indications TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery, and an increased mortality after delayed administration of TXA for trauma events or postpartum hemorrhage. Whereas most trials did not signal an increased risk for thrombotic events, some trials reported an increased rate of thrombotic complications with the use of TXA for gastro-intestinal bleeding and trauma. Conclusions TXA has well-documented beneficial effects in many clinical indications. Identifying these indications and the optimal dose and timing to minimize risk of seizures or thromboembolic events is work in progress.

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Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty

Abstract: Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.

Cited by 53 publications

References 73 publications

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

Can Tranexamic Acid Control Bleeding during and After Total Thyroidectomy? A Randomized Double-blind Clinical Trial Study

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

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