Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-23T12:44:23.669Z Has data issue: false hasContentIssue false
  • English
  • Français

Tranexamic acid in sinus and nasal surgery: an up-to-date meta-analysis

Published online by Cambridge University Press:  27 October 2021

D Yap ,
A Shakir  and
A Hunt
D Yap*
Affiliation:
Department of Otorhinolaryngology, Milton Keynes University Hospital, Milton Keynes, UK
A Shakir
Affiliation:
Department of Otorhinolaryngology, Milton Keynes University Hospital, Milton Keynes, UK
A Hunt
Affiliation:
Department of Otorhinolaryngology, Milton Keynes University Hospital, Milton Keynes, UK
*
Author for correspondence: Dr D Yap, Department of Otorhinolaryngology, Milton Keynes University Hospital, Standing Way, Eaglestone, Milton Keynes MK6 5LD, UK E-mail: darrenyap.jx@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

There are gaps within current meta-analyses looking at the effects of tranexamic acid on sino-nasal surgery. This study aimed to update and summarise all current available evidence on the use of tranexamic acid in sino-nasal surgery.

Method

A literature search was performed using four medical databases, Cochrane Library, Embase, Medline and PubMed. Data analysis was performed using dedicated meta-analysis software Review Manager (Revman).

Results

Thirteen studies were included in the meta-analysis. The amount of blood loss and duration of surgery in tranexamic acid groups was statistically lower than placebo for both sinus and nasal surgery. Tranexamic acid improves the surgical field quality in sinus surgery but worsens the field in nasal surgery. Topical or intravenous administration of tranexamic acid in sinus surgery reduces blood loss, duration of surgery and improves the quality of the surgical field.

Conclusion

This study suggests that the use of tranexamic acid in sinus surgery reduces blood loss, decreases surgical duration and improves surgical field quality.

Keywords

Tranexamic AcidTissue Plasminogen ActivatorNasal Surgical ProceduresBlood Loss, SurgicalRhinoplastyOtolaryngologyNose
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 8 , August 2022 , pp. 692 - 702
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr D Yap takes responsibility for the integrity of the content of the paper

References

Kang, H, Hwang, S. Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia? Braz J Otorhinolaryngol 2020;86:111–1810.1016/j.bjorl.2019.08.006CrossRefGoogle ScholarPubMed
Ping, W, Zhao, Q, Sun, H, Lu, H, Li, F. Role of tranexamic acid in nasal surgery – a systematic review and meta-analysis of randomized control trial. Medicine 2019;98:e15202CrossRefGoogle ScholarPubMed
Kim, D, Kim, S, Kang, H, Jin, H, Hwang, S. Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: a meta-analysis and systematic review. Laryngoscope 2018;129:800–710.1002/lary.27766CrossRefGoogle ScholarPubMed
Pundir, V, Pundir, J, Georgalas, C, Fokkens, W. Role of tranexamic acid in endoscopic sinus surgery – a systematic review and meta-analysis. Rhinology 201;51:291–710.4193/Rhino13.042CrossRefGoogle Scholar
Sterne, JAC, Savović, J, Page, MJ, Elbers, RG, Blencowe, NS, Boutron, I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l489810.1136/bmj.l4898CrossRefGoogle ScholarPubMed
Dongare, D, Saundattikar, G. Comparison of intraoperative bleeding and surgical fields with and without tranexamic acid in functional endoscopic sinus surgery. Ind J Clin Anaesth 2018;5:233–6Google Scholar
Ghavimi, M, Taheri Talesh, K, Ghoreishizadeh, A, Chavoshzadeh, M, Zarandi, A. Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double-blind study. J Craniomaxillofac Surg 2017;45:897–90210.1016/j.jcms.2017.03.001CrossRefGoogle ScholarPubMed
Eftekharian, H, Rajabzadeh, Z. The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty. J Craniofac Surg 2016;27:97–10010.1097/SCS.0000000000002273CrossRefGoogle ScholarPubMed
Sakallioğlu, Ö, Polat, C, Soylu, E, Düzer, S, Orhan, İ, Akyiğit, A. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 2015;74:392–610.1097/SAP.0b013e3182a1e527CrossRefGoogle ScholarPubMed
El Shal, S, Hasanein, R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egypt J 2015;31:1–7Google Scholar
Nuhi, S, Tabrizi, A, Zarkhah, L, Ashrafi, B. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iran J Otorhinolaryngol 2015;27:349–34Google ScholarPubMed
Shehata, A, Ibrahim, M, Abd-El-Fattah, M. Topical tranexamic acid versus hot saline for field quality during endoscopic sinus surgery. Egypt J Otolaryngol 2014;30:327CrossRefGoogle Scholar
Jahanshahi, J, Hashemian, F, Pazira, S, Bakhshaei, M, Farahani, F, Abasi, R et al. 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. PloS ONE 2014;9:e104477CrossRefGoogle ScholarPubMed
Eldaba, A, Amr, Y, Albirmawy, O. Effects of tranexamic acid during endoscopic sinsus surgery in children. Saudi J Anaesth 2013;7:229Google ScholarPubMed
Langille, M, Chiarella, A, Côté, D, Mulholland, G, Sowerby, L, Dziegielewski, P et al. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2012;3:315–1810.1002/alr.21100CrossRefGoogle ScholarPubMed
Alimian, M, Mohseni, M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anesth 2011;23:611–1510.1016/j.jclinane.2011.03.004CrossRefGoogle ScholarPubMed
Athanasiadis, T, Beule, A, Wormald, P. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol 2007;21:737–4210.2500/ajr.2007.21.3097CrossRefGoogle ScholarPubMed
Jabalameli, M, Zakeri, K. Evaluation of topical tranexamic acid on intraoperative bleeding in endoscopic sinus surgery. Iran J Med Sci 2006;31:221–3Google Scholar
Dunn, CJ, Goa, KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57:1005–3210.2165/00003495-199957060-00017CrossRefGoogle Scholar
Franchini, M, Mengoli, C, Marietta, M, Marano, G, Vaglio, S, Pupella, S et al. Safety of intravenous tranexamic acid in patients undergoing major orthopaedic surgery: a meta-analysis of randomised controlled trials. Blood Transfus 2018;16:36–43Google ScholarPubMed
Kim, Y, Park, J, Kim, J, Seo, D. Does Tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian population? Arch Orthop Trauma Surg 2018;138:83–9CrossRefGoogle ScholarPubMed
Baradaranfar, M, Dadgarnia, M, Mahmoudi, H, Behniafard, N, Atighechi, S, Zand, V et al. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iran J Otorhinolaryngol 2017;29:69–74Google ScholarPubMed
Mehdizadeh, M, Ghassemi, A, Khakzad, M, Mir, M, Nekoohesh, L, Moghadamnia, A et al. Comparison of the effect of dexamethasone and tranexamic acid, separately or in combination on post-rhinoplasty edema and ecchymosis. Aesthetic Plast Surg 2018;42:246–5210.1007/s00266-017-0969-xCrossRefGoogle ScholarPubMed
Chhapola, S, Matta, I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. Int J Clin Rhinol 2011;4:79–8110.5005/jp-journals-10013-1078CrossRefGoogle Scholar
Moise, A, Agachi, L, Dragulin, E, Mincu, N, Stelea, G. Tranexamic acid reduces with 50% the total nasal bleeding of patients that underwent functional endoscopic sinus surgery. Eur J Anaesthesiol 2010;27:11510.1097/00003643-201006121-00368CrossRefGoogle Scholar
Higgins, JPT, Thomas, J, Chandler, J, Cumpston, M, Li, T, Page, MJ et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane 2019. In: www.training.cochrane.org/handbook [31 December 2021]CrossRefGoogle Scholar