Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

Evaniew, Nathan; Bhandari, Mohit

doi:10.1007/s11999-016-5112-9

Cited by 10 publications

(2 citation statements)

References 15 publications

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“…Tranexamic acid (TXA) is an antifibrinolytic agent that has been used for decades in several surgical disciplines for its ability to reduce intraoperative blood loss and the need for blood transfusions [16,17], as well as reducing edema and postoperative ecchymosis [19]. It can be administered orally, topically, or intravenously [18,21,32]. .…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty

et al. 2020

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Background Hematoma is the most common complication in facelift surgery. It has a reported incidence ranging from 0.2 to 8%. Tranexamic acid (TXA) is an antifibrinolytic agent capable of minimizing blood loss, and its use in plastic surgery is quite new. The literature review indicates that there are no formal guidelines for dosing and standardization of TXA use. We sought to evaluate the efficacy of intraoperative local irrigation of TXA in reducing the incidence of hematomas in patients undergoing facelift surgery. Methods A prospective cohort observational comparative study was conducted between November 2018 and November 2019 with 30 patients undergoing primary facelift surgery at the Ivo Pitanguy Institute in Rio de Janeiro, Brazil. The participants were divided into two groups: group I, patients who underwent facelift with 2.5% topical TXA irrigation as a new routine of the service, and group II, patients who underwent facelift without topical TXA irrigation as a routine. Results Drainage output in the first 24 h, hematoma formation, and complication rate were evaluated. It was found that local intraoperative TXA irrigation reduces drainage output in the first 24 h by 71% compared with group II (median 10 ml (8-22 ml) versus 35 ml (19-50 ml); p = 0•009). The rate of postoperative complications (p = 0.1) and hematoma (p = 0.08) was lower in the group with intraoperative local irrigation with TXA. This was not statistically significant. Conclusion Local TXA irrigation seems to decrease bleeding and has been shown to be effective in reducing drainage output in the first 24 h postoperatively.Level of evidence: Level III, risk / prognostic study.

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Section: Introductionmentioning

confidence: 99%

Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty

et al. 2020

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“…5,6 Evidence suggests that tranexamic acid may also reduce postoperative edema and ecchymosis. 7 Tranexamic acid has been shown to be a safe medication, 5,8 with reported rates of serious complications, such as deep vein thrombosis and pulmonary embolism, similar to those of common medications like aspirin and warfarin sodium. 9 The use of tranexamic acid is well established in reconstructive craniofacial surgery 10,11 ; however, it is not commonly used in aesthetic plastic surgery.…”

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confidence: 99%

Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty

McGuire

Nurmsoo

Samargandi

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss.OBJECTIVE To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.DATA SOURCES A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications.STUDY SELECTION The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included.DATA EXTRACTION AND SYNTHESIS The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size. MAIN OUTCOMES AND MEASURESThe primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis.RESULTS Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 ( 7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of −41.6 mL (95% CI, −69.8 to −13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high.CONCLUSIONS AND RELEVANCE Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.LEVEL OF EVIDENCE 4.

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