Re-Evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized Double-Blinded Controlled Trial

Abstract

Background Nowadays, minimizing the surgical complications of rhinoplasty has gained more importance. Results from previous trials show that Tranexamic acid (TXA) reduces intraoperative bleeding, one of the major complicating factors during rhinoplasty. Objective To contribute to previous evidence by re-evaluating the efficacy of TXA, specifically in reducing intraoperative blood loss and increasing surgical field quality in rhinoplasty. Study Design and Methods A randomized placebo-controlled trial was conducted (IRCT20111219008458N2). The outcomes included total intraoperative blood loss, measured by the total volume of fluid collected by suction and gauzes, subtracted by volume of used irrigation fluids, and the quality of surgical field, measured by surgeon's satisfaction on a 5-point Likert scale. Demographics, blood coagulation measures, and clinical data were also collected and were held as covariates in analysis. After blinding, randomization, and group allocations, the intervention group received TXA 10mg/kg and the placebo group normal saline in equal volumes.Results Data of a total of 80 patients were gathered and analyzed. The total intraoperative blood loss was insignificantly lower (mean difference [95% CI]: -3.6 ( -19.19, 11.99), P = 0.65) and surgeon's satisfaction was insignificantly higher (mean difference [95% CI]: 0.18 ( -0.11, 0.46), P = 0.22) in TXA group. Results were confirmed by multivariable analysis. Conclusion In contrast to most of the previous studies, this study showed only a statistically insignificant decrease in total intraoperative blood loss in patients receiving TXA compared to placebo. Further studies are required to more precisely estimate the efficacy of TXA in reducing blood loss during rhinoplasty. Level of evidence: Level I, randomized controlled trial.

Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis

“…The eligibility criteria were applied to 1630 research articles, and only 13 research articles met the inclusion criteria. All 1617 research articles were excluded due to screening and selection by PRISMA guidelines [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46].…”

Modern use of tranexamic acid in facial plastic surgery

“…with the key objectives being reduced intraoperative blood loss and postoperative ecchymosis. When given intravenously, dosing ranged from 10 mg/kg to 1 g prior to the start of the procedure, followed by an additional 1 g or an additional three doses (one every 8 h) at the conclusion of the procedure [13,14 ▪ ,15–17,18 ▪▪ ]. In the comparison of administering one versus two doses, the additional dose did not lead to any added benefit [17].…”

“…During rhinoplasties, injury to the angular arteries while performing osteotomies is a key component to which bleeding is attributed [20]. Other techniques proposed to reduce bleeding include intraoperative hypotension, elevated head position, use of vasoconstrictors, and careful dissection, which may be helpful yet insufficient to deliver the desired results [14 ▪ ,18 ▪▪ ]. Methods to evaluate the efficacy of TXA on blood loss during rhinoplasties consisted of measuring the volume collected by gauzes and fluid collected by suction minus irrigation used [13,18 ▪▪ ,20].…”

“…Other techniques proposed to reduce bleeding include intraoperative hypotension, elevated head position, use of vasoconstrictors, and careful dissection, which may be helpful yet insufficient to deliver the desired results [14 ▪ ,18 ▪▪ ]. Methods to evaluate the efficacy of TXA on blood loss during rhinoplasties consisted of measuring the volume collected by gauzes and fluid collected by suction minus irrigation used [13,18 ▪▪ ,20]. Although some studies found that differences in intraoperative blood loss were statistically significant, the reported amount ranged from 10 to 25 ml using i.v.…”

“…medication to 55 ml with oral TXA, making the clinical significance questionable [11,13,15,20,21]. Two studies found no difference in blood loss [17,18 ▪▪ ]. In this instance, quality of the surgical field may be a more valuable asset to surgeons.…”