Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial

Wei-Dong Ping, Qi-Ming Zhao, Hua-Feng Sun, Hai-Shan Lu, Fei Li, Wei-Dong Ping, Qi-Ming Zhao, Hua-Feng Sun, Hai-Shan Lu, Fei Li

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.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Search results and selection procedure.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
The effect of tranexamic acid illustrated by forest plot diagram on blood loss.
Figure 5
Figure 5
The effect of tranexamic acid illustrated by forest plot diagram on surgical field quality.
Figure 6
Figure 6
Rates of ecchymosis expansion (A) and periorbital edema (B) in upper and lower periorbital area.
Figure 7
Figure 7
The effect of tranexamic acid illustrated by forest plot diagram on eyelid edema. (A) Edema of upper eyelid; (B) edema of lower eyelid.
Figure 8
Figure 8
The effect of tranexamic acid illustrated by forest plot diagram on periorbital ecchymosis. (A) Ecchymosis of upper eyelid; (B) ecchymosis of lower eyelid.
Figure 9
Figure 9
The effect of tranexamic acid illustrated by forest plot diagram on operation time.

References

    1. Saif AM, Farboud A, Delfosse E, et al. Assessing the safety and efficacy of drugs used in preparing the nose for diagnostic and therapeutic procedures: a systematic review. Clin Otolaryngol 2016;41:546–63.
    1. Samman N, Cheung LK, Tong AC, et al. Blood loss and transfusion requirements in orthognatic surgery. J Oral Maxillofac Surg 1996;54:21–4. 25–6.
    1. Cochran CS, Landecker A. Prevention and management of rhinoplasty complications. Plast Reconstr Surg 2008;122:60e–7e.
    1. Choi WS, Irwin MG, Samman N. The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg 2009;67:125–33.
    1. Ragab SM, Hassanin MZ. Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach. Otolaryngol Head Neck Surg 2010;142:48–54.
    1. Gutierrez S, Wuesthoff C. Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg (Oakv) 2014;22:83–7.
    1. Alajmi MA, Al-Abdulhadi KA, Al-Noumas HS, et al. Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty. Indian J Otolaryngol Head Neck Surg 2009;61:266–9.
    1. Karimi A, Mohammadi SS, Hasheminasab M. Efficacy of tranexamic acid on blood loss during bimaxilary osteotomy: a randomized double blind clinical trial. Saudi J Anaesth 2012;6:41–5.
    1. Later AF, Maas JJ, Engbers FH, et al. Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardiothorac Surg 2009;36:322–9.
    1. Lemay E, Guay J, Cote C, et al. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anaesth 2004;51:31–7.
    1. Herron J, French R, Gilliam AD. Civilian and military doctors’ knowledge of tranexamic acid (TXA) use in major trauma: a comparison study. J R Army Med Corps 2018;164:170–1.
    1. The Cochrane Collaboration; 2011;Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from . Accessed July 12, 2016.
    1. Mehdizadeh M, Ghassemi A, Khakzad M, et al. Comparison of the effect of dexamethasone and tranexamic acid, separately or in combination on post-rhinoplasty edema and ecchymosis. Aesthetic Plast Surg 2018;42:246–52.
    1. Ghavimi MA, Taheri TK, Ghoreishizadeh A, et al. Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double-blind study. J Craniomaxillofac Surg 2017;45:897–902.
    1. Baradaranfar MH, Dadgarnia MH, Mahmoudi H, et al. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iran J Otorhinolaryngol 2017;29:69–74.
    1. Jabalameli M, Zakeri K. Evaluation of topical tranexamic acid on intraoperative bleeding in endoscopic sinus surgery. Iran J Med Sci 2006;31:221–3.
    1. Eftekharian HR, Rajabzadeh Z. The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty. J Craniofac Surg 2016;27:97–100.
    1. Nuhi S, Goljanian TA, Zarkhah L, et al. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iran J Otorhinolaryngol 2015;27:349–54.
    1. Sakallioğlu Ö, Polat C, Soylu E, et al. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 2015;74:392–6.
    1. Jahanshahi J, Hashemian F, Pazira S, et al. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One 2014;9:e104477.
    1. Langille MA, Chiarella A, Cote DW, et al. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2013;3:315–8.
    1. Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anesth 2011;23:611–5.
    1. Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol 2007;21:737–42.
    1. Athanasiadis T, Beule A, Embate J, et al. Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope 2008;118:314–9.
    1. Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42(Pt 1):373–6.
    1. Zhang J. Effects of reptilase, tranexamic acid, carbazochrome sodium sulfonate on blood coagulation in patients undergoing endoscopy sinuses surgery. Chinese Journal Medicinal Guide 2008;10:234–6. 241.
    1. Ren Z, Li S, Sheng L, et al. Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study. Medicine (Baltimore) 2017;96:e8233.
    1. Lostak J, Gallo J, Vecera M, et al. Local application of tranexamic acid in total hip arthroplasty decreases blood loss and consumption of blood transfusion. Acta Chir Orthop Traumatol Cech 2017;84:254–62.
    1. Zabeeda D, Medalion B, Sverdlov M, et al. Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization. Ann Thorac Surg 2002;74:733–8.
    1. Reid RW, Zimmerman AA, Laussen PC, et al. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg 1997;84:990–6.
    1. Ekback G, Axelsson K, Ryttberg L, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg 2000;91:1124–30.
    1. Wang C, Xu GJ, Han Z, et al. Topical application of tranexamic acid in primary total hip arthroplasty: a systemic review and meta-analysis. Int J Surg 2015;15:134–9.
    1. Wang JW, Chen B, Lin PC, et al. The efficacy of combined use of rivaroxaban and tranexamic acid on blood conservation in minimally invasive total knee arthroplasty a double-blind randomized, controlled trial. J Arthroplasty 2017;32:801–6.
    1. Chen X, Xie S, Wang K. Effectiveness of tranexamic acid in total knee arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014;28:1338–41.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj