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

Abstract

Objectives Tranexamic acid might help control bleeding during surgery because of antifibrinolytic characteristics. We aimed to evaluate the effectiveness of systemic tranexamic acid compared to control in blood loss, operative time, and surgical field and incidence of postoperative emesis and thromboembolism in endoscopic sinus surgery. Methods Two authors independently searched six databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their inception to July 2018. The included studies compared perioperative tranexamic acid administration (treatment group) with a placebo, and the outcomes of interest were intraoperative morbidities, including surgical time, operative bleeding, and hypotension; postoperative morbidities such as nausea and vomiting; and coagulation profiles. Results Seven studies comprising 562 participants were reviewed in this study. Operative time (standardized mean difference (SMD) = −0.60; 95% confidence interval (CI)[−0.93, −0.29]) and intraoperative blood loss (SMD = −0.66; 95% CI [−0.86, −0.46]) were statistically lower in the treatment group than placebo group; and the quality of the surgical field (SMD = −0.80; 95% CI [−1.12; −0.48]) and surgeon satisfaction (SMD = 1.74; 95% CI [1.36; 2.13]) were statistically higher in the treatment group than the placebo group. By contrast, there were no significant differences in the hemodynamic (SMD = 0.08; 95% CI [−0.20; 0.37]) and coagulation profiles (SMD = −0.18; 95% CI [−0.42, 0.07]) of the two groups. Additionally, tranexamic acid had no significant effect on emetic or thrombotic events compared to placebo. Conclusion This meta‐analysis showed that the systemic administration of tranexamic acid could decrease operative time and blood loss intraoperatively, increasing the satisfaction of surgeons. It did not provoke intraoperative hemodynamic instability, postoperative emetic events, or coagulation profile abnormality. Only a small number of studies were enrolled, so further trials are needed to confirm the results of this study. Laryngoscope, 129:800–807, 2019

Intravenous Tranexamic Acid Improves the Intraoperative Visualization of Endoscopic Sinus Surgery for High-Grade Chronic Rhinosinusitis: A Randomized, Controlled, Double-Blinded Prospective Trial

“…In this study, despite the better surgical visualization in the TXA group, the reduction in blood loss and OT by TXA administration was not significant, which differs from the findings in a previous study ( 5 ). This difference might be related to the severity of the disease.…”

“…A systematic review (6) found that TXA improved the surgical field and reduced blood loss during nasal surgery. The meta-analysis performed by Kim et al ( 5 ) found that TXA reduced blood loss and operative time in endoscopic sinus surgery based on a small number of enrolled studies. Langille et al ( 7 ) applied a bolus TXA of 15 mg/kg with a continuous TXA infusion at 1 mg/kg/h and did not find decreased efficiency in the surgical field or intraoperative blood loss.…”

“…As an antifibrinolytic agent, tranexamic acid (TXA) has been demonstrated to prevent bleeding effectively in multiple clinical scenarios, including acute trauma, dental and obstetric procedures, orthopedic and cardiothoracic surgeries, hemoptysis, and epistaxis ( 4 ). A small number of studies have shown that the systemic administration of TXA can decrease intraoperative blood loss and operative time ( 5 , 6 ). However, this finding is controversial ( 7 ), and adverse effects should be evaluated synchronously.…”

Outcomes of combined use of topical and intravenous tranexamic acid on surgical field quality during functional endoscopic sinus surgery: Randomized controlled trial

“…Specifically, we found that the best quality of the surgical field was obtained in patients who received the combined both topical and IV TA (group C), followed by those who received the IV TA (group A), while those who received the topical TA (group B) had the lowest surgical field quality. Various studies have shown that IV administration of TA significantly decreased intraoperative bleeding as compared to control groups, with no detection of significant thrombotic events or alterations in coagulation parameters postoperatively 20,22‐24 . It remains to be mentioned that fentanyl consumption was significantly lower in group C as compared to the other groups, and hence, that led to a significantly shorter recovery time.…”

Can Tranexamic Acid Control Bleeding during and After Total Thyroidectomy? A Randomized Double-blind Clinical Trial Study

“…In addition to BL during surgery, post-surgery BL is also one of the major complications of thyroidectomy that leads to the patient not being discharged and prolongation of the hospitalization period, the respiratory tract being jeopardized, and even reoperation in some cases. [4,5] Some studies have hitherto been conducted on TA effectiveness in head and neck surgeries, as well as elective and emergency operations, [6,7] but studies dedicated to thyroid surgeries have been very limited. The present study aims to investigate the impact of TA in controlling BL during and after thyroid surgery in Shahid Rahnemoun Hospital in Yazd, Iran during 2018 and 2019.…”