Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery

Ravesloot, Madeline J. L.; Lourijsen, Evelijn; Avdeeva, Klementina; Pundir, Vishal; Fokkens, Wytske J.

doi:10.1002/14651858.cd012843

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…[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. 8 This study evaluated the effect of 1 g of IV TXA given 15 min prior to extubation in reducing postoperative epistaxis when compared with control (i.e., saline). The dosage kept in line with prior studies involving iv TXA in otolaryngology.…”

Section: Discussionmentioning

confidence: 99%

“…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 18–21 . 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 8 …”

Section: Discussionmentioning

confidence: 99%

“…In the field of otolaryngology, it has been demonstrated to both reduce intraoperative blood loss and improve the endoscopic visual field 7 . However, its effect on postoperative epistaxis has not been evaluated, despite the development of a Cochrane review with this outcome listed as a secondary outcome of interest 8 . The purpose of this study is to assess the clinical efficacy of TXA when given intraoperatively at the end of the case to reduce postoperative bleeding, as well as the need for additional interventions to control epistaxis after routine sinus and nasal surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Khanwalkar

Chan

Roozdar

et al. 2023

Int Forum Allergy Rhinol

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BackgroundPostoperative epistaxis is a known possibility following endoscopic sinonasal surgery. Tranexamic acid (TXA) has been shown to reduce intraoperative blood loss and improve the visual field. This study evaluated the clinical efficacy of TXA when given at end of surgery to reduce postoperative bleeding.MethodsThis randomized, double‐blinded placebo‐controlled trial was conducted from April to November 2021. Patients scheduled to undergo endoscopic sinus or nasal surgery were randomized to receive an intravenous dose of 1 g TXA or saline intraoperatively prior to extubation. A 10‐in. visual analog scale (VAS) was used to query patients regarding postoperative bleeding each day for 1 week. The medical record was examined to determine the need for additional evaluations or interventions for epistaxis.ResultsForty patients completed the study. The mean ± SD postoperative bleeding VAS for the TXA group on the day of surgery was not significantly different from the saline group (4.82 ± 2.18 in. vs. 5.03 ± 2.14 in., p = 0.8). There were no significant differences between treatment arms on any postoperative day through day 7 (0.67 ± 1.84 in. vs. 0.87 ± 0.99 in., p = 0.7), nor in the reduction in VAS compared to the respective baseline on the day of surgery. There were no significant differences in terms of additional interventions (e.g., additional evaluation in recovery, ED, or clinic, need for packing, or return to the operating room [OR]).ConclusionAlthough TXA has previously demonstrated efficacy to reduce intraoperative bleeding during sinonasal surgery, when postoperative bleeding is already minimal at baseline, TXA does not appear to reduce it significantly further.

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