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

Abstract

BackgroundThe effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet. This study was conducted to answer this question.MethodsThis trial was conducted on 60 patients with chronic sinusitis at Beasat Hospital, Hamadan, Iran, from April to November 2013. Thirty patients in the intervention group received three pledgets soaked with TXA 5% and phenylephrine 0.5% for 10 minutes in each nasal cavity before surgery. Thirty patients in the control group received phenylephrine 0.5% with the same way. The amount of bleeding and the quality of surgical field were evaluated at 15, 30, and 45 minutes after the start of surgery using Boezaart grading.ResultsThe quality of the surgical field in the intervention group compared to the control group was significantly better in the first quarter (P = 0.002) and the second quarter (P = 0.003) but not in the third quarter (P = 0.163). Furthermore, the amount of bleeding was much less during all periods in the intervention group than in the control group (P = 0.001).ConclusionTopical TXA can efficiently reduce bleeding and improve the surgical field in FESS in patients with rhinosinusitis. Based on these findings, topical TXA may be a useful method for providing a suitable surgical field during the first 30 minutes after use.Trial RegistrationIranian Registry of Clinical Trials IRCT201212139014N15

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

“…Intraoperative hemorrhage control is one of the most important factors for improving the surgical field to ensure a successful operation. Due to the narrow operative field of the nasal cavity, even slight bleeding can distort the view of the endoscope and increase the occurrence of important structure injuries, cause the surgery to take longer, or even result in inconclusive surgery . The previous meta‐analysis demonstrated that topical or systemic tranexamic acid decreases intraoperative bleeding and enhances surgical field quality, similar to our results.…”

“…Due to the narrow operative field of the nasal cavity, even slight bleeding can distort the view of the endoscope and increase the occurrence of important structure injuries, cause the surgery to take longer, or even result in inconclusive surgery. 27 The previous metaanalysis demonstrated that topical or systemic tranexamic acid decreases intraoperative bleeding and enhances surgical field quality, 24 similar to our results. Reasonably, improvement in the quality of the surgical field correlated with the surgeon's satisfaction.…”

Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial

“…The efficacy of topical application of the injectable form of tranexamic acid (TXA) has been shown beneficial for the treatment of idiopathic anterior epistaxis . Additionally, topical use of TXA during oral, pulmonary, sinus, and adenoidectomy procedures results in significantly less mucosal bleeding. In this study, we compared the effect of topical TXA with ANP for treatment of anterior epistaxis in patients taking antiplatelet drugs.…”

Tranexamic acid in epistaxis: a systematic review

“…Extrapolating from other clinical applications, two RCTs showed that topical TXA in FESS significantly improved visual field and reduced blood loss; however, the trials were small and one had a high risk of bias. A large ( n = 400) well‐designed trial found that topical TXA applied post‐adenoidectomy in children reduced blood loss and primary haemorrhage rate.…”