Comprehensive assessment of tranexamic acid during orthognathic surgery: A systematic review and meta-analysis of randomized, controlled trials

Zhao, Haoming; Liu, Shaopeng; Wu, Zuping; Zhao, Hongxia; Ma, Chuan

doi:10.1016/j.jcms.2019.01.021

Cited by 23 publications

(21 citation statements)

References 26 publications

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“…19 Usually, the maxilla is more vascular than the mandible; blood loss during maxillary surgery therefore accounts for a large percentage of the total blood loss, especially in bimaxillary OS settings. 14 Unlike other current meta-analysis, 3,5,15 this study evaluated only bimaxillary OS surgery, in order to decrease the impact of procedure on the pooled effect. The data demonstrated that TXA use resulted in a sparing of approximately 264.82 mL (P < .001; 95% CI: À380.60 to À149.04 mL) of blood in bimaxillary OS compared to the placebo, and the results of subgroup and sensitivity analyses further validated effect of TXA on blood-saving potency.…”

Section: Discussionmentioning

confidence: 99%

“…2,20 However, the efficacy of TXA did not cause a reduction in operation time in bimaxillary OS (WMD, À8.71 minutes; 95% CI: À20.98 to 3.57 minutes; P ¼ .164), which was different from the result of previous meta-analysis. 5 One likely explanation for this finding is that the operation time for OS is not solely dependent on the quality of the surgical field but rather on several other important factors, including the complexity of the osteotomy design and the surgical skill of the operating surgeon. One previous study reported that TXA could reduce the length of hospital stay in OS patients; however, our meta- a "Yes" indicates "low risk of bias"; "No" indicates "high risk of bias";"?"…”

Section: Discussionmentioning

confidence: 99%

“…A previous meta-analysis compared efficacy of different doses of TXA on blood loss during single maxillary and bimaxillary OS. 5 However, we did not conduct the dosedependent subgroup analysis, simply because of limited enrolled studies and possible heterogeneity of routes of TXA administration. Instead, we performed a subgroup analysis on methods of TXA use, intravenous and topical (irrigation fluid)…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TXA) exerts its antifibrinolytic effect by blocking the lysine-binding sites on plasminogen molecules, increasing the clotting potential of blood, thereby reducing blood loss. 5 Currently available data have proved the efficacy and safety of TXA in surgeries with high-risk bleeding, such as cardiac, 6 orthopedic, 7 and neurosurgical. 8 In this context, prophylactic use of TXA in craniofacial and OS has been suggested in order to minimize bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…2,[9][10][11][12][13][14] On the other hand, currently published meta-analyses included all types of OS and neglected routes of TXA administration. 3,5,15 Accordingly, considering unique role of bimaxillary OS in the clinical settings, we conducted a meta-analysis of randomized controlled trials (RCTs) to comprehensively assess the role of TXA during bimaxillary OS.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

2020

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Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

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