Role of tranexamic acid in nasal surgery

Abstract

Objective: Nasal surgeries (such as Functional Endoscopic Sinus Surgery, Rhinoplasty, and Septorhinoplasty) are popular procedures. But perioperative bleeding, eyelid edema, and periorbital ecchymosis remain problems. Tranexamic acid (TXA) is an antifibrinolytic, and it was used to reduce the perioperative bleeding. However, there is no enough evidence judging its safety and efficiency. Therefore, a meta-analysis is conducted by us to evaluate the role of TXA in patients undergoing nasal surgeries. Method: A search of the literature was performed until June 2018; the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. Only randomized controlled trial (RCT) articles were included, and subgroup analysis was established to deal with heterogeneity. RevMan 5.3 software was selected to conduct the meta-analysis. Result: Eleven RCTs were included in our meta-analysis. There were significant differences in blood loss ( P < .001), surgical field quality ( P < .001), edema rating of upper ( P < .001) and lower ( P < .001) eyelid, ecchymosis rating of upper ( P < .001) and lower eyelid ( P < .001) when comparing the TXA group to the placebo group. However, the difference in operation time ( P = .57) was not significant between the two groups. Conclusion: Perioperative TXA could reduce the blood loss and improve the quality of surgery field during nasal surgery, and it was helpful for reducing the edema and ecchymosis after nasal surgeries, but it has little influence in reducing the operation time.

Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery

“…Randomized controlled trials on the use of tranexamic acid in rhinoplasty generally address systemic administration. 20,22…”

“…Randomized controlled trials on the use of tranexamic acid in rhinoplasty generally address systemic administration. 20,22 In the four randomized controlled trials by our group and Zilinsky's group 31,58,60,61 (Tables 1 and 2), the effect of tranexamic acid alone as a hemostatic was examined, although both groups normally use cocktails with both lidocaine and adrenaline. More research is needed on a possible synergy between adrenaline and tranexamic acid for hemostasis in soft tissue.…”

“…Both systemic and topical use of tranexamic acid have already been explored in plastic surgical fields that involve skeletal structures such as rhinoplasty, craniomaxillofacial, and orthognathic surgery. [19][20][21][22] Yet, the larger bulk of plastic surgery takes place in soft tissue, and the effect of tranexamic acid according to type of tissue may be as clinically relevant as the effect in specific procedures.…”

Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery

“…7,16,17 A separate meta-analysis of 11 RCTs came to these same conclusions. 16 Placebo-controlled trials specifically examining iv TXA given at induction of anesthesia have demonstrated a significant reduction in intraoperative bleeding and improved surgical visualization, although one recent RCT did not demonstrate any such benefit. [18][19][20][21] A Cochrane review in 2017 proposed postoperative bleeding as a target outcome, but no designed studies since that time had been identified to answer the question.…”

Self-Expandable Retainer for Endoscopic Visualization in the External Auditory Canal: Proof of Concept in Human Cadavers

“…Bleeding in EES is a major concern for the operating surgeon because the non-dominant hand also must hold the endoscope. Techniques utilized to achieve hemostasis include diathermy probes (monopolar and bipolar) [11], diluted epinephrine injection, epinephrine-soaked cotton balls that can also be used as adjuncts for soft tissue dissection [18], and preoperative injection of tranexamic acid [12] which is an anti-fibrinolytic used in a variety of surgical procedures [19][20][21].…”