Usefulness of Tranexamic Acid Administration During Sagittal Split Ramus Osteotomy

Abstract

Tranexamic acid has been used to reduce intraoperative bleeding; however, its effect on anti-inflammation and the amount of drainage after orthognathic surgery is yet to be determined. Therefore, we aimed to examine the effect of tranexamic acid on intraoperative bleeding volume and operation time, amount of drainage, and anti-inflammation after orthognathic surgery. Forty healthy women who underwent bilateral sagittal split ramus osteotomy under general anesthesia participated in this study. The amount of intraoperative bleeding, the operation time, the amount of drainage, and the C-reactive protein level were compared between patients intravenously administered with tranexamic acid before surgery (before-surgery group) and those administered with the drug after surgery (after-surgery group). All data were analyzed using the Student t-test. Results were considered to be statistically significant when P < 0.05. Although no significant difference was found in the amount of drainage between the groups (P > 0.05), significant variations were detected in the amount of bleeding during surgery (before-surgery group: 161.7 ± 45.3 mL versus after-surgery group: 270.2 ± 24.0 mL; P = 0.0009), operation time (before-surgery group: 141.3 ± 16.8 min versus after-surgery group: 166.8 ± 24.9 min; P = 0.03), and postoperative C-reactive protein level (before-surgery group: 3.77 ± 0.40 mg/dL versus after-surgery group: 5.02 ± 0.75 mg/dL; P = 0.012) between the groups. In conclusion, administering tranexamic acid before surgery was found to significantly decrease bleeding, reduce operation time, and suppress postoperative inflammation.

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

“…45 This correlates with other properties of TXA as early treatment benefits the most when looking at blood loss and mortality due to bleeding. 4,45 This may be interpreted as TXA having a greater effect if administered before the activation of the coagulation system.…”

“…19,[47][48][49][50] The majority of included studies were RCTs, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40]43,44,[46][47][48][49][50] while five were cohort studies including a control group. 19,34,41,42,45 The participants in most of the articles were undergoing elective surgery (n ¼ 3,563) 19-39,41--47,49,50 of which 13 studies investigated total knee arthroplasty patients which, at least partly, is an inflammatory condition (n ¼ 1,918), 20,22,24,25,27,34,35,[37][38][39]42,...…”

“…[21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA. 21,27,31,35,45 Inflammatory Biomarkers ►Table 1 shows a summary of the 14 included studies that investigated inflammatory markers in TXA patients and compared them to either a group receiving placebo or no medication, [19][20][21]25,26,29,30,32,34,36,40,42,[48][49][50] while ►Table 2 presents a summary of 14 articles that investigated inflammatory biomarkers in surgical patients receiving TXA and compared them to a single group or several groups receiving either fewer or lower doses of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,...…”

“…One included article by Draxler et al 19 consisted of two independent studies which resulted in 33 studies being included. Among those, 10 rated good 20 21 22 23 24 25 26 27 28 29 while 18 rated fair 19 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 and five rated poor. 19 47 48 49 50 The majority of included studies were RCTs, 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 35 36 37 38 39 40 43 44 46 47 48 49 50 while five were cohort studies including a control group.…”

“…35 Yoshida et al investigated if TXA affected inflammatory biomarkers in patients dependent on whether TXA were administered before or after surgery, and demonstrated a decrease in biomarker levels among the group receiving TXA preoperatively compared with those receiving TXA postoperatively. 45…”