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Vogt AZ, Kivanany PB, De Niear MA, Vrcek IM, Homer NA. The Effect of Intravenous Tranexamic Acid on Postoperative Ecchymoses after Upper Blepharoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6089. [PMID: 39188959 PMCID: PMC11346880 DOI: 10.1097/gox.0000000000006089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/26/2024] [Indexed: 08/28/2024]
Abstract
Background Tranexamic acid has been increasingly used in facial plastic surgery to improve perioperative hemostasis. While subcutaneous tranexamic acid has been found to not significantly decrease postoperative ecchymoses following upper blepharoplasty, systemic administration has not previously been studied. Methods A total of 325 patients undergoing upper blepharoplasty were randomly assigned to either receive intravenous tranexamic acid or serve as a control. Patients in the experimental group were administered 1 g of tranexamic acid intravenously 10 minutes before surgical incision. A similar upper blepharoplasty technique was performed by two American Society of Ophthalmic Plastic and Reconstructive Surgery-trained surgeons. Follow-up was conducted at a median of 8 days postsurgery. Patient photographs were evaluated by two independent graders to rate ecchymoses on a scale of 0 (least) to 10 (most). Results Of the 325 included patients, 138 patients received intravenous tranexamic acid and 187 patients did not. The average ecchymosis rating for the control group at day 8 was 5.8 ± 1.7, while the average rating for the tranexamic acid group at the same time point was 4.1 ± 1.6 (P < 0.0001). There was a trend toward decreased ecchymoses in the tranexamic acid group at earlier and later postoperative timepoints that did not reach statistical significance. No hemorrhagic or systemic embolic complications occurred. Conclusions Systemic tranexamic acid may reduce postoperative ecchymoses after upper blepharoplasty surgery, reaching significance at the eighth postoperative day, which may lead to improved patient satisfaction and decreased occupational downtime.
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Affiliation(s)
- Ashtyn Z. Vogt
- From the Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Okla
| | - Pouriska B. Kivanany
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Tex
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Teng TZJ, Chia AZQ, Gan KF, Tan LHP, Wang Y, Charn TC. A Comparison of Tranexamic Acid in Nasal Versus Sinus Surgeries: a Systematic Review and Meta-Analysis. Indian J Otolaryngol Head Neck Surg 2024; 76:3018-3030. [PMID: 39130301 PMCID: PMC11306473 DOI: 10.1007/s12070-024-04579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 08/13/2024] Open
Abstract
Nasal surgeries (e.g.: rhinoplasties, septoplasties) and sinus surgeries (e.g.: Functional Endoscopic Sinus Surgeries) are common procedures in Otorhinolaryngology. Tranexamic acid (TXA), an antifibrinolytic drug, has been increasingly utilized to reduce hemorrhage recently. While close in proximity anatomically, the bleeding nature of sinus and nasal surgeries may differ. We present the first meta-analysis that has reviewed both nasal and sinus surgery collectively and compares the two. Pubmed, Embase, Cochrane Library and WoS were searched until April 2023. Outcomes of interest include Boezart Scoring, clotting time, postoperative complications and surgical field quality. 27 Studies were assessed, of which 25 studies were evaluated quantitatively. Of the 27 studies, 15 studies involved Sinus surgery while 12 involved Nasal surgery. The use of tranexamic acid was notably beneficial in the evaluation of blood loss, reduction of operating time, surgical field quality and surgeon satisfaction. TXA has proven to be efficacious in both nasal and sinus surgeries to varying degrees. TXA has more effects in sinus surgeries compared to nasal surgeries in objective markers such as reducing blood loss and operating time, but the converse occurs for subjective markers such as surgeon satisfaction scores. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-04579-x.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Ministry of Health Holdings, Singapore, Singapore
- Department of Otorhinolaryngology - Head and Neck surgery, Sengkang General Hospital, Singhealth, Singapore
| | | | - Keith Fei Gan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Lydia Hui Peng Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Yuxing Wang
- Ministry of Health Holdings, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology - Head and Neck surgery, Sengkang General Hospital, Singhealth, Singapore
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Tyle MR, Olafson A, Hiro ME, Payne WG. Clearing the Smoke: The Evidence behind Risk of Electrocautery Smoke and Mitigation Strategies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6039. [PMID: 39139844 PMCID: PMC11321753 DOI: 10.1097/gox.0000000000006039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024]
Abstract
Background Electrocautery has been a useful, fundamental instrument utilized for surgical procedures since its implementation in the 1920s. However, concerns exist regarding the health hazards of the by-product smoke associated with the use of electrocautery. Methods A comprehensive review of articles on the composition, mitigation, and effects of smoke was conducted using the PubMed search engine and excluding articles that did not meet the predetermined inclusion criteria. From January 1963 to December 2021, a total of 264 articles resulted, and a total of 69 articles were included in this narrative review. Results Surgical smoke contains volatile organic compounds, polycyclic aromatic compounds, viral particles, and ultrafine particles. There has been some evidence of mutagenicity to bacterial cells during animal in vivo studies, and one human survey study has shown similar mutagenic effects. We also discuss additional hemostatic techniques that can be used, including the use of hemostatic and antithrombolytic agents, epinephrine infiltration, and the use of tourniquet when appropriate. Conclusions Further studies should be conducted regarding human effects, but until the data are available, we recommend precautionary measures and actions to protect operating room staff from cautery smoke exposure.
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Affiliation(s)
- Madison Rose Tyle
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
| | - Amra Olafson
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
| | - Matthew E. Hiro
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
- Department of Plastic Surgery, Bay Pines VA Healthcare System, Plastic Surgery Section, Bay Pines, Fla
| | - Wyatt G. Payne
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
- Department of Plastic Surgery, Bay Pines VA Healthcare System, Plastic Surgery Section, Bay Pines, Fla
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Kolasiński J, Reysner T, Kolenda M, Kołacz S, Domagalska M. A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery. Perioper Med (Lond) 2024; 13:52. [PMID: 38831387 PMCID: PMC11149283 DOI: 10.1186/s13741-024-00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Tranexamic acid has been widely used in plastic surgery. However, its efficacy has yet to be fully established. This meta-analysis aimed to determine its effectiveness in aesthetic plastic surgery. METHODS Following PRISMA guidelines, we conducted a meta-analysis of prospective randomised clinical trials that compared the effects of topical or systematic administration of tranexamic acid versus the control group in aesthetic plastic surgeries. The study was registered on the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42023492585). RESULTS Eleven studies encompassing 960 patients were included for the synthesis after critical evaluation. Systematic (MD - 18.05, 95% Cl, - 22.01, - 14.09, p < 0.00001) and topical (MD - 74.93, 95% Cl, - 88.79, - 61.07, p < 0.00001) administration of tranexamic acid reduced total blood loss. Topical tranexamic acid reduced drainage output (p < 0.0006). CONCLUSION Tranexamic acid reduced blood loss in aesthetic plastic surgery. More strictly defined RCTs, using high-quality methodology, are needed to evaluate the advantages and disadvantages of tranexamic acid in aesthetic plastic surgery.
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Affiliation(s)
| | - Tomasz Reysner
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznań, Poland
| | | | - Szymon Kołacz
- Kolasinski Clinic, Hair Clinic Poznan, 62-020, Swarzędz, Poland
| | - Małgorzata Domagalska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznań, Poland.
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Gutierrez RWH, Gobbo HR, Heringer LDFL. Tranexamic Acid in Patients Undergoing Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024; 48:2076-2085. [PMID: 38097691 DOI: 10.1007/s00266-023-03768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/17/2023] [Indexed: 06/06/2024]
Abstract
BACKGROUND Rhinoplasty is one of the most popular aesthetic plastic surgeries worldwide. The effects of tranexamic acid (TXA) in patients undergoing rhinoplasty are still being studied to guide a better management. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) analyzing the effects of TXA in patients undergoing rhinoplasty. The outcomes evaluated were blood loss, postoperative edema, postoperative ecchymosis, surgery duration and surgeon satisfaction. RESULTS Eleven studies comprising 841 patients were included. Overall, TXA reduced total blood loss regardless of dose and administration route (MD = - 39.37 mL; 95% CI = - 62.70 to - 16.05 mL; p = 0.0009; I2 = 92%), using intravenous 10 mg/kg of TXA preoperatively (MD = - 16.30 mL; 95% CI = - 29.49 to - 2.57 mL; p = 0.02; I2 = 61%) and using 1 g of oral TXA preoperatively (MD = - 61.70 mL; 95% CI = - 83.02 to - 40.39 mL; p < 0.00001; I2 = 0%). TXA also decreased edema (MD = - 0.78; 95% CI = - 1.28 to - 0.27 points; p = 0.003; I2 = 80%) and ecchymosis (MD = - 1.13; 95% CI = - 1.99 to -0.28; p = 0.01; I2 = 93%) on postoperative day one (POD 1). Surgeon satisfaction was increased (SMD = 1.55; 95% CI = 0.33 to 2.77; p = 0.01; I2 = 95%). However, there was no difference in surgery duration (SMD = - 0.26; 95% CI = - 0.56 to 0.04; p = 0.09; I2 = 36%). CONCLUSION This study found a significant reduction in blood loss, periorbital edema and periorbital ecchymosis, along with an improvement in surgeon satisfaction. These results hold the potential to optimize the rhinoplasty management by plastic surgeons. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | | | - Luzimagno da Fonseca Lemos Heringer
- Member of the Brazilian Society of Plastic Surgery (SBCP), São Paulo, Brazil
- Head of Plastic Surgery Department, Desembargador Leal Junior Hospital, Itaboraí, Rio de Janeiro, Brazil
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Meretsky CR, Polychronis A, Schiuma AT. Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis. Cureus 2024; 16:e62482. [PMID: 39015854 PMCID: PMC11251670 DOI: 10.7759/cureus.62482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/18/2024] Open
Abstract
With increasing interest in aesthetic plastic procedures, the event of blood loss has compromised patients' safety and satisfaction. Tranexamic acid (TXA) is a drug used for the reduction of blood loss during surgical procedures. This systematic review aims to evaluate the clinical efficacy and safety of TXA in aesthetic plastic surgery for the reduction of bleeding and related complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. The medical subject headings (MeSH) keywords used for data extraction were ("TXA," OR "tranexamic acid,") AND ("plastic surgery," OR "aesthetic surgery," OR "rhinoplasty," OR "blepharoplasty,") AND ("blood loss" OR "bleeding" OR "TBL") AND ("Edema" OR "ecchymosis"). A combination of these MeSH terms was used in the literature search. The timeline of research was set from 2015 to January 2024. A total of 7380 research articles were identified from the above-mentioned databases, and only 13 research articles met the inclusion criteria. There was a significant difference in total blood loss (TBL) among patients who had undergone plastic surgery procedures while on TXA as compared to a placebo (mean difference = -6.02; Cl: -1.07 to -0.16; p > 0.00001), and heterogeneity was found (degrees of freedom (df) = 9; I2 = 97%). Only two studies reported the average ecchymosis scores after TXA among interventions in comparison to the placebo group. This review provides evidence that TXA lowers TBL, ecchymosis, edema, and anemia during cosmetic surgery without significantly increasing thromboembolic consequences.
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Turhal G, Berber V, Isler E, Gode S. Peroperative Cooling in Rhinoplasty: Does it Differ? Aesthetic Plast Surg 2024:10.1007/s00266-024-04105-y. [PMID: 38806826 DOI: 10.1007/s00266-024-04105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
The main causes of ecchymosis and edema are osteotomy (bone manipulation), dissection of subcutaneous tissue, and skin manipulation in the rhinoplasty procedure. Eyelid edema following surgery can potentially affect visual acuity, particularly during the initial twenty-four hours after the procedure. These may also delay the patient's return to their normal social life therefore hampering their quality of life. Various surgical and medical methods have been reported to address these issues. This study aimed to compare the effects of using cold saline (0-4 °C) versus room temperature saline (20-25 °C) irrigation throughout the surgery on postoperative edema, ecchymosis, and pain. Fifty patients who underwent open-approach primary rhinoplasty between August 2022 and August 2023 at a tertiary academic center were included. Fifty patients were randomly divided into two groups depending on using cold saline (0-4 °C) (group 1) or room temperature saline (20-25 °C) (group 2) during surgical site irrigation. Patients were assessed for pain, edema, and bruising using a VAS (Visual Analog Scale) on the second and seventh postoperative days. Visual analog score (VAS) was used for subjective outcome analyses. Each patient scored the severity of their periorbital ecchymosis on day two and seven. Periorbital ecchymosis was also evaluated on the second and seventh postoperative days using the SPREE (Surgeon Periorbital Rating of Edema and Ecchymosis) scale. On the second postoperative day, the VAS pain score in group 1, where cold water was used, was found to be statistically and significantly different from the control group (group 2) (p < 0.05). However, there was no statistically significant difference between both groups when comparing the VAS pain scores on the seventh postoperative day. Regarding the VAS ecchymosis score on the seventh postoperative day, there was a statistically significant difference favoring group 1 (p < 0.05). The SPREE scale data also indicated that group 1 had significantly lower scores on the seventh day (p < 0.05). While the SPREE scores on the second day were lower in group 1 than in group 2, this difference did not reach statistical significance (p = 0.061). The findings from our study show that cold saline irrigation may contribute to intraoperative hemostasis by inducing local vasoconstriction. We observed that intraoperative bleeding decreased with the use of cold saline. This approach has the potential to improve patient satisfaction and overall quality of life by reducing postoperative ecchymosis without significantly increasing the cost of the surgical procedure.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Goksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Veysel Berber
- Department of Otolaryngology, Sarikamis State Hospital, 36500, Kars, Turkey.
| | - Efe Isler
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Sercan Gode
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
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Marous CL, Farhat OJ, Cefalu M, Rothschild MI, Alapati S, Wladis EJ. Effects of Preoperative Intravenous Versus Subcutaneous Tranexamic Acid on Postoperative Periorbital Ecchymosis and Edema Following Upper Eyelid Blepharoplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled, Comparative Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00379. [PMID: 38687303 DOI: 10.1097/iop.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE To compare the effects of preoperative tranexamic acid (TXA) administered intravenously (IV) versus subcutaneously on postoperative ecchymosis and edema in patients undergoing bilateral upper eyelid blepharoplasty. METHODS A prospective, double-blinded, placebo-controlled study of patients undergoing bilateral upper eyelid blepharoplasty at a single-center. Eligible participants were randomized to preoperatively receive either (1) 1 g of TXA in 100 ml normal saline IV, (2) 50 µl/ml of TXA in local anesthesia, or (3) no TXA. Primary outcomes included ecchymosis and edema at postoperative day 1 (POD1) and 7 (POD7). Secondary outcomes included operative time, pain, time until resuming activities of daily living, patient satisfaction, and adverse events. RESULTS By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), ecchymosis scores were significantly lower on POD1 (1.31 vs. 1.56 vs. 2.09, p = 0.02) and on POD7 (0.51 vs. 0.66 vs. 0.98, p = 0.04) among those that received TXA. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), significant reductions in edema scores occurred in those that received TXA on POD1 (1.59 vs. 1.43 vs. 1.91, p = 0.005) and on POD7 (0.85 vs. 0.60 vs. 0.99, p = 0.04). By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA) patients treated with intravenous and local subcutaneous TXA preoperatively were more likely to experience shorter operative times (10.8 vs. 11.8 vs. 12.9 minutes, p = 0.01), reduced time to resuming activities of daily livings (1.6 vs. 1.6 vs. 2.3 days, p < 0.0001), and higher satisfaction scores at POD1 (8.8 vs. 8.7 vs. 7.9, p = 0.0002). No adverse events occurred were reported. CONCLUSION In an analysis of 106 patients, preoperative TXA administered either IV or subcutaneously safely reduced postoperative ecchymosis and edema in patients undergoing upper eyelid blepharoplasty. While statistical superiority between intravenous versus local subcutaneous TXA treatment was not definitively identified, our results suggest clinical superiority with IV dosing.
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Affiliation(s)
- Charlotte L Marous
- Oculoplastic and Orbital Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | - Omar J Farhat
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | - Matthew Cefalu
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | | | | | - Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
- Department of Otolaryngology and Head and Neck Surgery, Albany Medical College, Albany, New York, U.S.A
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Stein MJ, Yuksel SS, Harrast J, Taub PJ, Matarasso A, Gosain AK. Clinical Practice Patterns and Evidence-Based Medicine in Rhinoplasty: A 10-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesthetic Plast Surg 2024; 48:1312-1320. [PMID: 37605029 DOI: 10.1007/s00266-023-03599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery from member surgeons since 2003. These data offer valuable information on national trends in clinical practice. OBJECTIVES The present study was performed to analyze trends in rhinoplasty over the last decade. METHODS Tracer data were compared between two cohorts 2012-2016 (early cohort "EC") and 2017-2021 (recent cohort "RC"). Data included patient demographics and surgical techniques. Results were considered in the context of current EBM-based guidance in the plastic surgery literature. RESULTS Data from 730 rhinoplasties (270 EC and 460 RC) were analyzed. The median age was 30 years, and the most common patient concern was the nasal dorsum (79%). In the RC group, fewer patients voiced concerns about tip projection (58% vs 43%, p = 0.0002) and more complained of functional airway problems (38% vs 49%, p = 0.004). An open approach was most common (83%). Septoplasty (47% vs 52%, p = 0.005), caudal septum repositioning (14% vs 23%, p = 0.002), and tip rotation maneuvers (32% vs 49%, p < 0.0001) became more popular. There was also an increase in the use of spreader grafts (35% vs 45%, p = 0.01) and columellar strut grafts (42% vs 50%, p = 0.04), while there has been a decrease in alar base resection (17% vs 10%, p = 0.007) and non-cartilaginous dorsum/radix augmentation (9% vs 4%, p = 0.02). CONCLUSIONS ABPS tracer data provide an excellent resource for the objective assessment of procedures in plastic surgery. The present study is the first to highlight evolving trends in rhinoplasty over the last 10 years. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Michael J Stein
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Selcen S Yuksel
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA
| | - John Harrast
- Data Harbor Solutions, American Board of Plastic Surgery, Philadelphia, PA, USA
| | - Peter J Taub
- American Board of Plastic Surgery and Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Alan Matarasso
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA.
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Goncalves PE, Ferreira FJS, Lima AS, Moreira DC, de Oliveira Santos BF, Melo NAD, Beer-Furlan A, Oliveira AMP. Tranexamic acid in bleeding reduction and operative time of nasal surgeries: systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:1105-1114. [PMID: 37864748 DOI: 10.1007/s00405-023-08291-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE Our study goal is to review the efficacy of tranexamic acid in reducing blood loss and operative time in nasal surgeries. METHODS We included randomized clinical trials using oral or intravenous tranexamic acid, excluded non-randomized studies, topic administration, coagulopathy, and using other drugs interfering in the coagulation cascade. Online databases, National Library of Medicine (MEDLINE-PubMED), Latin American and Caribbean Literature on Health Sciences (Lilacs), Cochrane Library, Embase and Google Scholar were used to perform the search. The review was registered in PROSPERO by no CRD42022310977. Two authors, independently, selected the articles meeting the inclusion criteria. They extracted the data and used RevMan 5 software to perform the meta-analysis. RESULTS Our search resulted in 16 RCTs that were included in the meta-analysis totalizing 1108 patients. Studies were evaluated resulting in a low risk of bias for the five domains. The use of tranexamic acid resulted in significant reduction in duration of surgery (DOS) and intraoperative blood loss (IBL) had significant reduction. The level of evidence according to GRADE System was high in all studies and variables. CONCLUSION Tranexamic acid has an important role in reducing intraoperative blood loss and duration of surgery. Our study has some limitations due to the low number of RCTs available in the literature.
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Affiliation(s)
- Paulo Eduardo Goncalves
- Department of Medicine, Federal University of Sergipe, Claudio Batista St, Aracaju, SE, 49060-100, Brazil.
| | | | - Alice Santos Lima
- Department of Medicine, Federal University of Sergipe, Claudio Batista St, Aracaju, SE, 49060-100, Brazil
| | - Dandara Carvalho Moreira
- Department of Neurosurgery, Hospital de Cirurgia, 174, Desembargador Maynard, Cirurgia, Aracaju, SE, Brazil
| | | | - Nelson Almeida D'Avila Melo
- Department of Otolaryngology, Tiradentes University, 300, Murilo Dantas Avenue, Farolândia, Aracaju, SE, Brazil
| | - André Beer-Furlan
- Department of Skull Base and Endovascular Surgery, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Arthur Maynart Pereira Oliveira
- Department of Medicine, Federal University of Sergipe, Claudio Batista St, Aracaju, SE, 49060-100, Brazil
- Department of Neurosurgery, Hospital de Cirurgia, 174, Desembargador Maynard, Cirurgia, Aracaju, SE, Brazil
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11
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Vaghardoost R, Ahmadi Dahaj A, Haji Mohammad M, Ghadimi T, Forghani SF, Naderi Gharahgheshlagh S. Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial. Aesthetic Plast Surg 2024; 48:702-708. [PMID: 37452132 DOI: 10.1007/s00266-023-03441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS The purpose of this study was assessing the effect of local injection of tranexamic acid (TXA) on the amount of bleeding during the primary rhinoplasty and edema and ecchymosis following the surgery. METHODS In this randomized clinical trial, 50 patients applying for primary rhinoplasty were divided into two groups of intervention and observation. In the intervention group, 10 mg/kg of TXA was injected locally to the operation field. In the observation group, no medicine was injected. The same anesthesia technique was used during the operation for all the patients. Age, sex, blood pressure, bleeding amount during the operation, the amount of edema and ecchymosis on the first and seventh day after the surgery were noted. The data were analyzed by the SPSS software version 24 and using descriptive statistics of frequency and percentage of frequency and Fisher and Mann-Whitney's exact statistical tests. RESULTS Our results showed that there was a significant difference between the amounts of bleeding during the surgery between two groups (P-value < 0.001). Also, the postoperative edema on the first and seventh day in intervention group was less than the observation group (P-value < 0.001). There were no complications during the surgery and in the follow-up of the patients. CONCLUSION We revealed that local injection of TXA during the rhinoplasty procedure and decreased the intraoperative bleeding and postoperative ecchymosis and edema without any side effects and complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Reza Vaghardoost
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Ahmadi Dahaj
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran.
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Tayyeb Ghadimi
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Siamak Farokh Forghani
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Naderi Gharahgheshlagh
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
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Calim M, Karaaslan K, Yilmaz S, Senturk E, Deniz H, Akbas S. The Effects of Hypocapnia and Hypercapnia on Intraoperative Bleeding, Surgical Field Quality, and Surgeon Satisfaction Level in Septorhinoplasty: A Prospective Randomized Clinical Study. Aesthetic Plast Surg 2024; 48:167-176. [PMID: 37407709 DOI: 10.1007/s00266-023-03433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Septorhinoplasty (SRP) is one of the most commonly performed procedures in the world for functional and aesthetic purposes. The present study was aimed to compare the effects of hypocapnia and hypercapnia regarding the total amount of intraoperative bleeding, surgical field quality, and surgeon satisfaction level. METHODS In this randomized prospective clinical study, eighty patients with American Society of Anesthesiologists I-II and were 18-45 years old scheduled for septorhinoplasty were randomly allocated to group hypocapnia [end-tidal carbon dioxide (EtCO2) 30 ± 2 mmHg] and group hypercapnia (EtCO2 40 ± 2 mmHg). We evaluated the total amount of intraoperative bleeding, the surgical field quality, surgeon satisfaction level, hemodynamics and peri- and postoperative adverse events. RESULTS Group hypocapnia significantly reduced the total amount of intraoperative bleeding (p < 0.001). The surgical field quality and surgeon satisfaction level in group hypocapnia were significantly better than group hypercapnia (p < 0.001). EtCO2 levels of group hypocapnia were significantly lower than group hypercapnia at all time points (p < 0.001 for all time points). There were no significant differences between the groups in terms of heart rate and mean arterial pressure at all time points. There were no significant differences between the groups in terms of adverse events CONCLUSIONS: The results of this double-blind randomized clinical trial showed that reducing the amount of intraoperative bleeding for patients with hypocapnia undergoing SRP through known methods (e.g., reverse Trendelenburg head-up position, positive end-expiratory pressure limiting, controlled hypotension, and use of topical vasoconstrictors, corticosteroids, and tranexamic acid) would improve the quality of the surgical field and raise the surgeon satisfaction level. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sinan Yilmaz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hilal Deniz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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13
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Lonie S, Abesamis GM, Law J, Mohaghegh MH, Vickery K, Deva A, Tavakoli K. Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes. Aesthet Surg J 2023; 44:NP23-NP27. [PMID: 37427875 DOI: 10.1093/asj/sjad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Breast augmentation mammaplasty (BAM) remains the most popular cosmetic procedure done worldwide. Bleeding in this procedure increases the chance of capsular contracture. Tranexamic acid (TXA), an antifibrinolytic, has been widely used by other surgical specialties to reduce bleeding. OBJECTIVES We aimed to evaluate the use of TXA in BAM surgery. METHODS This was a single-surgeon case series of all patients who underwent primary BAM from March 2017 to March 2018 and received topical TXA spray to the implant pocket before implant insertion. Early postoperative complications and long-term outcomes, such as capsular contracture and revisional surgery, were recorded and described. RESULTS Two hundred and eighty-eight patients were included in the study with an overall complication rate of 2.8% over 5 years. No patients had postoperative bleeding or hematoma formation. One patient had a seroma, managed with ultrasound drainage. Complications requiring reoperation included rippling (3, 1.0%), pocket revision (2, 0.7%), capsule contracture (1, 0.3%) and rupture (1, 0.3%). CONCLUSIONS This study highlights the safety and potential benefits of the use of topical TXA in breast augmentation, with low bleeding and capsular contracture rates. LEVEL OF EVIDENCE: 4
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14
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Bayter-Marín JE, Hoyos A, Cárdenas-Camarena L, Peña-Pinzón W, Bayter-Torres AF, Díaz-Díaz CA, McCormick-Méndez M, Plata-Rueda EL, Niño-Carreño CS. Effectiveness of Tranexamic Acid in the Postoperative Period in Body Contour Surgery: Randomized Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5403. [PMID: 38025645 PMCID: PMC10653580 DOI: 10.1097/gox.0000000000005403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background Tranexamic acid (TXA) is used to reduce bleeding in body contouring procedures; however, there are no studies that show the effectiveness of TXA when it is also used in the immediate postoperative period. Methods A controlled, randomized, parallel, and open-label clinical trial was carried out in adult patients undergoing liposculpture and/or abdominoplasty. A control group administering presurgical TXA and a study group with presurgical and postsurgical TXA were formed. The decrease in hemoglobin and the incidence of blood transfusions between both groups were compared as well as the possible adverse effects of TXA. Results Four hundred twenty-seven subjects were included, 208 (48.7%) in the control group and 219 (51.3%) in the study group. The median age was 34 years (interquartile range 28-42). Median postoperative hemoglobin levels at 24 hours were similar in both groups (study 11.3 g/dL versus control 11.1 g/dL, P = 0.07); however, at 72 hours, postoperative hemoglobin was higher in the study group versus control (10.8 versus 10.0 g/dL, P ≤ 0.001). The incidence of transfusions at 72 hours was 1.8% in the study group and 8.6% in the control group, for a risk ratio of 0.21 (95% confidence interval 0.07-0.61). There were no adverse or thromboembolic events. Conclusion TXA proved to be more effective in reducing intra- and postsurgical bleeding and the need for transfusions, when used preoperatively and continued for 48 hours after surgery, than when used only preoperatively, without reporting adverse or thromboembolic effects.
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Affiliation(s)
- Jorge Enrique Bayter-Marín
- From the Universidad Industrial de Santander
- Department of Reanimation Critical and Intensive Care, Universidad La Sabana, Bucaramanga, Colombia
- Clínica “EL Pinar” Bucaramanga, Colombia
| | | | | | - William Peña-Pinzón
- Department of Anesthesiology and Perioperative Medicine, Fundación Universitaria Sanitas, Bucaramanga, Colombia
| | | | | | | | - Erika Liliana Plata-Rueda
- Department of Anesthesiology and Perioperative Medicine, Universidad Industrial de Santander, Fundación Universitaria Sanitas, Bucaramanga, Colombia
| | - Claudia Stella Niño-Carreño
- Department of Anesthesiology and Perioperative Medicine, Fundación Universitaria Sanitas, Bucaramanga, Colombia
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15
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Luetzenberg FS, Lyford-Pike S. Modern use of tranexamic acid in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2023; 31:219-223. [PMID: 37052603 DOI: 10.1097/moo.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW Although tranexamic acid is commonly used in surgical fields such as obstetrics, orthopedics, and trauma, its utilization in facial plastic surgery is a recently emerging concept, and studies examining its potential impact have been few. This review highlights how tranexamic acid may be employed during facial plastic procedures and the promising impact it may have. RECENT FINDINGS Tranexamic acid is primarily being studied in rhinoplasties and rhytidectomies, with intravenous administration and local infiltration being the most common routs of application, respectively. During rhinoplasties, tranexamic acid has the potential to improve the visualization of the surgical field by decreasing blood loss and to improve postoperative edema and ecchymosis. For rhytidectomies, on the contrary, it may shorten time to attain hemostasis, lessen the rate of hematoma formation, and lead to lower surgical drain output. Its efficacy is preserved at low doses, and significant medication side effects have not been reported after facial plastic procedures. SUMMARY Altogether, tranexamic acid may present a valuable adjuvant to facial plastic surgery, as it could increase both surgeon and patient satisfaction while exhibiting a benign safety profile.
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Affiliation(s)
- Friederike S Luetzenberg
- University of Minnesota, Department of Otolaryngology-Head and Neck Surgery, Minneapolis, Minnesota, USA
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16
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Akbarpour M, Jalali MM, Akbari M, Nasirmohtaram S, Haddadi S, Habibi AF, Azad F. Investigation of the effects of intranasal desmopressin on the bleeding of the patients during open septorhinoplasty: A randomized double-blind clinical trial. Heliyon 2023; 9:e17855. [PMID: 37455992 PMCID: PMC10344754 DOI: 10.1016/j.heliyon.2023.e17855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty. Materials and methods This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated. Results In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant. Conclusion Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies.
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Affiliation(s)
- Maliheh Akbarpour
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir-Mohammad Jalali
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Akbari
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Faghih Habibi
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Azad
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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17
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Coombs DM, Kwiecien GJ, Sinclair NR, Jin A, Zins JE. Local Infiltration of Tranexamic Acid During Facelift Improves Operating Room Efficiency: A Matched Patient Study. Aesthet Surg J 2022; 42:971-977. [PMID: 35350068 DOI: 10.1093/asj/sjac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has rapidly gained popularity in aesthetic surgery. Previous reports have suggested that TXA provides a dry surgical field and significantly reduces operating time during facelift surgery. OBJECTIVES The aim of this study was to build upon earlier findings by providing a large cohort matched alongside historic controls and more clearly document time saved when performing facelift surgery. METHODS A retrospective, single-surgeon case-control study was undertaken between July 2016 and October 2021. All patients underwent facelift surgery alone or in combination with fat transfer and perioral chemical peel. All patients received subcutaneous infiltration of 0.5% lidocaine/1:200,000 epinephrine with or without 1 or 2 mg/mL TXA. Patient demographics, TXA dose, surgical time, and minor and major complications were examined. RESULTS In total 145 consecutive patients were identified: 73 in Group 1 (no-TXA) and 72 in Group 2 (TXA). No differences in terms of gender distribution (P = 0.75), age (P = 0.54), BMI (P = 0.18), frequency of secondary rhytidectomy (P = 0.08), rate of ancillary lipografting (P = 0.44), TXA dose (P = 0.238), and minor complication rate (P = 0.56) were observed. However, mean surgical time in the no-TXA group was 21 minutes longer than in the TXA group (P = 0.016). Six patients (8%) in the no-TXA group experienced minor complications vs 8 patients (11%) in the TXA group. No patients experienced major complications. CONCLUSIONS Although previous studies have highlighted the potential benefits of TXA in aesthetic surgery, most of the data remain subjective and non-validated. This report adds to the objective body of evidence supporting TXA in facial aesthetic surgery by documenting time saved in the operating room without additional surgical morbidity. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Alison Jin
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - James E Zins
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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18
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Laikhter E, Comer CD, Shiah E, Manstein SM, Bain PA, Lin SJ. A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery. Aesthet Surg J 2022; 42:548-558. [PMID: 34486647 DOI: 10.1093/asj/sjab333] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. OBJECTIVES This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. METHODS A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. RESULTS Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, -40.0 to -12.7 mL; P < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (odds ratio, 0.280; 95% CI, 0.076-1.029; P = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, 3 studies found statistically significant reductions in postoperative drain output, and 1 study reported significantly improved surgical site quality for patients who received TXA (P = 0.001). CONCLUSIONS TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Elizabeth Laikhter
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Carly D Comer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Eric Shiah
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Samuel M Manstein
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Paul A Bain
- Countway Library, Harvard Medical School , Boston, MA , USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
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19
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Zins JE, Dutton JW. Commentary on: A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery. Aesthet Surg J 2022; 42:559-561. [PMID: 34922333 DOI: 10.1093/asj/sjab420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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20
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The effects of 5-degree, 10-degree and 20-degree reverse Trendelenburg positions on intraoperative bleeding and postoperative Edemea and ecchymosis around the eye in open rhinoplasty. Am J Otolaryngol 2022; 43:103311. [PMID: 34894451 DOI: 10.1016/j.amjoto.2021.103311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations. MATERIALS AND METHODS Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kg-1 propofol, 1 μg.kg-1 fentanyl, and 0.6 mg/kg rocuronium for muscle relaxation. Maintenance of anesthesia was provided with a minimum alveolar concentration of 1-1.5 with sevoflurane, 1:1 O2/N2O. Hemodynamic variables, intraoperational bleeding, postoperative 1st, 3rd and 7th days ecchymosis and edema around the eyes of the patients were compared between the groups. RESULTS Edema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p < 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p < 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p < 0.017). CONCLUSION We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.
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21
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Zins JE, Dutton JW. Invited Discussion on: Re-evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized double-blinded controlled Trial. Aesthetic Plast Surg 2022; 46:1321-1322. [PMID: 34981155 DOI: 10.1007/s00266-021-02679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
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22
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Tranexamic Acid in sinus and nasal surgery: an up-to-date meta-analysis. The Journal of Laryngology & Otology 2021; 136:692-702. [PMID: 34702390 DOI: 10.1017/s0022215121003170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Fuzi J, Budiono GR, Meller C, Jacobson I. Tranexamic acid in otorhinolaryngology - A contemporary review. World J Otorhinolaryngol Head Neck Surg 2021; 7:328-337. [PMID: 34632348 PMCID: PMC8486689 DOI: 10.1016/j.wjorl.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022] Open
Abstract
Tranexamic acid (TXA) is an anti-fibrinolytic agent which has been proven beneficial in multiple surgical specialties where significant bleeding can occur. Whilst it has been widely available for over 40 years its use within Otorhinolaryngology is still limited. Operations in Otorhinolaryngology are particularly varied with some such as tonsillectomy having the potential for significant life threatening bleeding. Other operations are performed within small confined surgical fields and even small amounts of bleeding can significantly detriment surgical field and increase technical difficulty and operative time. This review evaluated the current literature on the benefits of tranexamic acid within the field of Otorhinolaryngology and Head and Neck Surgery. Overall TXA was demonstrated to be a safe drug with no major adverse effects including thromboembolic events reported in any study. It has been shown to be of particular benefit in rhinology by improving surgical field, reducing operative time and reducing postoperative swelling and ecchymosis. The benefit in tonsillectomy is less clear and further studies are required to evaluate its potential use in the reduction of post tonsillectomy haemorrhage rates.
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Affiliation(s)
- Jordan Fuzi
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, New South Wales, Australia
| | | | - Catherine Meller
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, New South Wales, Australia
| | - Ian Jacobson
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, New South Wales, Australia
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24
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Afzali SL, Panahi H, Ganji F, Ziaei S, Sedaghat N. Re-Evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized Double-Blinded Controlled Trial. Aesthetic Plast Surg 2021; 46:1314-1320. [PMID: 34585263 DOI: 10.1007/s00266-021-02594-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/12/2021] [Indexed: 12/30/2022]
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.: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sayed Lotfollah Afzali
- Department of Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hesam Panahi
- Department of Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Forouzan Ganji
- Department of Community Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sanaz Ziaei
- Department of Pediatric Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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25
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The Effects of Intraoperative Local Tranexamic Acid on Periorbital Edema and Ecchymosis in Septorhinoplasty. J Craniofac Surg 2021; 32:e526-e530. [PMID: 33534311 DOI: 10.1097/scs.0000000000007493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The aim of the present study is to examine the effect of local administration of tranexamic acid (TXA) through lateral osteotomy line on postoperative periorbital edema and ecchymosis. MATERIALMETHOD Thirty patients underwent open technical septorhinoplasty were included. Before lateral osteotomies, the surgeon opened narrow subperiosteal tunnels on the both sides. After lateral osteotomies, the surgeon irrigated TXA into the right tunnel with the broken tip of the injection and the same amount of saline into the left tunnel. The patient's photographs were taken on the first, third, and seventh postoperative days. Periorbital edema and ecchymoses were evaluated by the blinded author. The statistical differences between the 2 sides were analyzed. RESULTS Lower Eyelid Edema values were significantly lower in the TXA(+) group than the TXA(-) group on the third day (P = 0.001). There was no statistically significant difference between the sides in terms of lower eyelid edema values on the first and seventh days (P = 0.065, P = 0.317). Upper and lower eyelid ecchymosis values were significantly lower in TXA(+) group than TXA(-) group on the first, third, and seventh days (P < 0.05). Upper eyelid edema values were found to be significantly lower in the TXA(+) group than the TXA(-) group on the first and third days (P = 0.002, P = 0.005). There was no statistically significant between the sides in terms of upper eyelid edema (P = 0.315) on the seventh day. CONCLUSIONS It was observed in the present study that local administration of TXA in septorhinoplasty was effective in reducing postoperative periorbital edema and ecchymosis.Level of evidence: 2c.
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Cristel RT, Demesh D, Patel MJ, Shah AR. Quantitative Analysis of Tranexamic Acid Effects on Ecchymosis in Rhinoplasty. Facial Plast Surg Aesthet Med 2021; 24:228-232. [PMID: 34166107 DOI: 10.1089/fpsam.2021.0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Many methods have been described to reduce postoperative ecchymosis in rhinoplasty with tranexamic acid (TXA) remaining controversial. TXA remains a consideration for surgeons, however, may have serious side effects, including seizures, blood clots, and vision changes. Methods: A prospective study of primary rhinoplasty patients was performed from March 2019 to June 2019. TXA was used in 50 patients and postoperative ecchymosis was compared with 50 control patients. Adobe Photoshop was used to quantitate postoperative ecchymosis using multiple objective color scales. Results: One hundred subjects were enrolled in the study. Eighty-four females and 16 males were included. Photographs were taken on postoperative day 7. There were no significant differences among any of the Red, Green, Blue (RGB) and L*a*b* color subgroups with p > 0.05. There were no adverse events with TXA. Conclusions: In this study, TXA did not reduce postoperative ecchymosis in rhinoplasty when used both through intravenous and intraoperative injections.
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Affiliation(s)
- Robert T Cristel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Demesh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Manish J Patel
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Anil R Shah
- Shah Facial Plastic Surgery, Chicago, Illinois, USA
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Fathimani K, Perenack J, Christensen BJ. The Use of Tranexamic Acid in Facial Cosmetic Surgery Procedures: A Technical Note. J Oral Maxillofac Surg 2021; 79:2334-2338. [PMID: 34245699 DOI: 10.1016/j.joms.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022]
Abstract
Tranexamic acid (TXA) has been widely used as an antifibrinolytic in dentoalveolar surgery and only recently has its effects been explored in facial procedures. Multiple studies have reported the use of TXA in facial cosmetic surgery; and to date, only a limited number of them utilized TXA as a local infiltrative technique for rhytidectomy procedures. We present a technical note to using lower concentrations of TXA in tumescent anesthesia for an array of facial cosmetic procedures. Our experience thus far has shown improved hemostasis, reduction of intraoperative bleeding and a more profound reduction in postoperative ecchymosis, edema and seroma formation.
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Affiliation(s)
- Kayvan Fathimani
- Facial Cosmetic Surgery Fellow, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA.
| | - Jon Perenack
- Facial Cosmetic Surgery Fellowship Director and Associate Clinical Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Tranexamic acid in plastic surgery: routes of administration and dosage considerations. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Does Intraoperative Ketorolac Increase Bleeding in Oculoplastic Surgery? Ophthalmic Plast Reconstr Surg 2021; 36:355-358. [PMID: 31809483 DOI: 10.1097/iop.0000000000001549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To report adverse hemorrhagic outcomes in patients who received intravenous (IV) ketorolac during oculofacial plastic surgical procedures. METHODS The medical records of 111 consecutive patients who underwent lacrimal or orbital surgery, between the years 2016 and 2018, performed by a single surgeon under general anesthesia were retrospectively reviewed. Patients were excluded if they had history of a bleeding coagulopathy, anticoagulant use prior to surgery, or insufficient follow up. Patients were divided into 2 groups based on whether they received intravenous ketorolac. The primary outcome measure was the occurrence of a major postoperative bleeding event, and the secondary outcome measures were the evaluation of postoperative ecchymosis graded at 1 week after surgery and the incidence of persistent ecchymosis beyond 4 weeks. RESULTS A total of 111 patients were analyzed further, including 31 patients who received intraoperative IV ketorolac and 80 control patients who did not. The demographic characteristics between the 2 groups were similar. No major bleeding events occurred in either group. And there was no statistically significant difference between the 2 groups in terms of ecchymosis grade and the incidence of development of persistent ecchymosis. Comparing the subgroups of lacrimal and orbital cases, there was also no significance difference between these groups. CONCLUSIONS This study suggests that intraoperative ketorolac use does not increase the risk of postoperative bleeding complications in oculofacial procedures. This alternative to opioids may assist with pain control and lessen the narcotic burden.
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Elena Scarafoni E. A Systematic Review of Tranexamic Acid in Plastic Surgery: What's New? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3172. [PMID: 33907653 PMCID: PMC8062149 DOI: 10.1097/gox.0000000000003172] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures. METHODS A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery. RESULTS A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis. CONCLUSIONS The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.
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Affiliation(s)
- Esteban Elena Scarafoni
- From the Department of Plastic and Reconstructive Surgery, Hospital de Quemados, Buenos Aires, Argentina
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Fayman M, Beeton A, Potgieter E, Ndou R, Mazengenya P. Efficacy of Topical Tranexamic Acid (Cyclokapron) in "Wet" Field Infiltration with Dilute Local Anaesthetic Solutions in Plastic Surgery. Aesthetic Plast Surg 2021; 45:332-339. [PMID: 33051719 DOI: 10.1007/s00266-020-02001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Surgical bleeding may lead to the need for blood transfusion and minimizing blood loss has been a basic principle followed by surgeons for generations. Antifibrinolytic agents are widely used to reduce perioperative haemorrhage. The present study sought to assess the efficacy of directly infiltrated tranexamic acid in ameliorating bruising in participants undergoing cosmetic plastic surgery (liposuction). MATERIALS AND METHODS The study employed a blinded, prospective, randomized, case control design. Thirty-three patients were studied. Tranexamic acid free infiltration tumescent solution (saline, bupivacaine lignocaine and adrenalin) was infiltrated to one flank of patients undergoing liposuction of flanks. The other flank was infiltrated with the same tumescent solution (saline, bupivacaine lignocaine and adrenalin) mixed with tranexamic acid (0.1%). Bruises were photographed one and seven days after surgery and measured for size. The surface area of the bruises was calculated using ImageJ software. We compared the bruised surface are between the tranexamic acid infiltrated flank and non-tranexamic acid infiltrated flank in the same patient. The model employed involved measuring the bruises on each flank of the same patient, with surgery by a single surgeon using the same infiltration and surgical techniques for both sides. The only variable was the difference in tranexamic acid concentration between study and control flanks. RESULTS We found that use of tranexamic acid consistently resulted in a smaller bruise area on days one and seven after liposuction of flanks. Results were statistically significant. CONCLUSIONS This is the first study examining addition of tranexamic acid to a tumescent infiltration solution-to produce a predictable local concentration of tranexamic acid-in order to maximize surgical site effect and minimize systemic effect. The authors recommend incorporation of tranexamic acid as a routine component along with adrenaline and local anaesthetics in tumescent field infiltration solution 10-15 min before commencement of the cosmetic surgery. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Wokes JET, Erdmann MWH, McLean NR. The Role of Tranexamic Acid in Aesthetic Plastic Surgery: A Survey of the British Association of Aesthetic Plastic Surgeons. Aesthet Surg J 2021; 41:244-249. [PMID: 32505129 DOI: 10.1093/asj/sjaa149] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) can reduce intra- and postoperative bleeding as well as minimizing postoperative swelling and ecchymosis. It can be administered both intravenously and topically during surgery with minimal side effects. OBJECTIVES To assess the evidence of TXA use in aesthetic surgery and to complete a survey of current practice of full British Association of Aesthetic Plastic Surgeons members. METHODS The authors performed a literature review and online survey of full British Association of Aesthetic Plastic Surgeons members. RESULTS There is an increased indication of TXA utilization in aesthetic surgery. It provides multiple surgeon and patient benefits. CONCLUSIONS TXA is a useful adjunct in aesthetic surgery.
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Affiliation(s)
- James E T Wokes
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Matthias W H Erdmann
- Department of Plastic and Reconstructive Surgery, University Hospital North Durham, Durham, United Kingdom
| | - Neil R McLean
- Department of Plastic and Reconstructive Surgery, Wansbeck District General Hospital, Ashington, United Kingdom
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Efficacy of Dexamethasone for Reducing Edema and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2020; 44:1672-1684. [PMID: 32383002 DOI: 10.1007/s00266-020-01743-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Rhinoplasty is one of the most challenging cosmetic surgical operations. The procedure has been known to precipitate higher levels of edema and ecchymosis in the periorbital and paranasal regions. The literature recommends the use of corticosteroids such as dexamethasone to alleviate these postoperative morbidities. In this review, we aim to provide a current state of evidence concerning the influence of dexamethasone together with rhinoplasty on intraoperative and postoperative morbidities. METHODS A systematic identification of the literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis compared the influence of dexamethasone and normal saline administered during rhinoplasty on the amount of intraoperative blood loss, postoperative edema and ecchymosis. RESULTS Out of 1045 records, ten articles including 374 participants (mean age: 25.8 ± 2.5 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of dexamethasone during rhinoplasty to reduce the amount of intraoperative blood loss, edema and ecchymosis as compared to normal saline. The meta-analysis reveals beneficial effects for dexamethasone interventions by demonstrating medium to large effect reduction of the amount of intraoperative blood loss (Hedge's g: - 0.69), mean edema score (- 1.09) and mean ecchymosis score (- 1.03) as compared to placebo groups using normal saline. CONCLUSION The current systematic review and meta-analysis recommend the administration of dexamethasone with rhinoplasty. The review reports beneficial effects of dexamethasone's administration as compared to normal saline for reducing the amount of intraoperative blood loss, postoperative edema and ecchymosis. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Khiabani K, Ahmadfar M, Labafchi A, Gosheh MR, Samieirad S. Is Preoperative Administration of Tranexamic Acid Effective on Blood Loss Reduction in Mandibular Fracture Surgeries? A Triple-Blind Randomized Clinical Trial. J Oral Maxillofac Surg 2020; 79:429.e1-429.e7. [PMID: 33035492 DOI: 10.1016/j.joms.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Hemorrhage is one of the significant factors that cause adverse reactions and complications during trauma management. This study aimed to investigate the effectiveness of preoperative tranexamic acid (TXA) administration on intraoperative blood loss in mandibular fracture surgeries. MATERIALS AND METHODS The authors implemented a triple blinded randomized clinical trial. All healthy young patients who suffered from bilateral displaced mandibular angle and body fractures were included in this study. All operations were performed using open reduction and internal fixation by the same surgical team. The eligible subjects were randomly divided into 2 equal groups. The anesthesiology staff administered the intravenous TXA (20 mg/kg) to the intervention group and 20 mL of intravenous normal saline (0.09%) in the control group, 30 minutes preoperatively. The study outcome variables included intraoperative blood loss and hemoglobin loss. The data were statistically analyzed in SPSS, version 20 (SPSS Inc, Chicago, IL). RESULTS Fifty patients, including 31 males (62%) and 19 females (38%), with the mean age of 28 ± 5.6 years were studied. The mean blood loss was 360.57 ± 173.5 mL and 560.9 ± 248.07 mL in the TXA and control groups, respectively. This difference was statistically significant (P = .008). In addition, the mean drop in hemoglobin value was 0.91 ± 0.33 mg/dL in the intervention group and 1.44 ± 0.45 mg/dL in the control group, with a significant difference (P = .001). No adverse effect was observed in the TXA cases. CONCLUSIONS TXA is a safe and effective drug for reducing intraoperative blood loss in patients who underwent mandibular fracture open reduction and internal fixation surgeries.
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Affiliation(s)
- Kazem Khiabani
- Associate Professor, Department of Oral & Maxillofacial Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Ahmadfar
- Oral & Maxillofacial Surgeon, Private Practice, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Labafchi
- Dentist, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Gosheh
- Assistant Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sahand Samieirad
- Associate Professor, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Locketz GD, Lozada KN, Bloom JD. Tranexamic Acid in Aesthetic Facial Plastic Surgery: A Systematic Review of Evidence, Applications, and Outcomes. Aesthet Surg J Open Forum 2020; 2:ojaa029. [PMID: 33791652 PMCID: PMC7671246 DOI: 10.1093/asjof/ojaa029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background Tranexamic acid (TXA) is an antifibrinolytic that has become widely used in aesthetic facial plastic surgery, although its efficacy has not been well investigated. Objectives To evaluate the existing evidence for use of TXA in aesthetic facial plastic surgery, highlighting routes of administration, dosing, surgical applications, and clinical outcomes. Methods Systematic review of primary literature evaluating TXA in aesthetic facial plastic surgery. Results Eleven studies met inclusion criteria: 8 prospective randomized controlled trials, 2 retrospective case series/cohort studies, and 1 clinical opinion. Six studies evaluated TXA in rhinoplasty, 4 in rhytidectomy, and 1 in blepharoplasty. Significant reductions in intraoperative blood loss were found in 5 rhinoplasty studies. Three rhinoplasty and 2 rhytidectomy studies found significantly reduced postoperative edema and ecchymosis. One rhinoplasty and 1 rhytidectomy study reported reduced operative time and time to achieve hemostasis. One rhytidectomy study reported reduced postoperative drain output and faster time to drain removal. No studies reported an adverse outcome directly related to TXA. Conclusions Existing literature investigating TXA in aesthetic facial plastic surgery is sparse with varying levels of evidence and heterogeneous data. Literature suggests systemic TXA reduces intraoperative blood loss during rhinoplasty, although the clinical significance of this blood loss reduction is unclear. TXA may also reduce postoperative edema and/or ecchymosis in rhytidectomy and rhinoplasty, although the lack of validated grading scales yields insufficient evidence to support this claim. Topical and subcutaneously injected TXA are emerging administration routes in rhytidectomy, with evidence suggesting TXA mixed with tumescent may reduce postoperative drain output, thereby expediting drain removal. Level of Evidence: 2 ![]()
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Affiliation(s)
- Garrett D Locketz
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Corresponding Author: Dr Garrett D. Locketz, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA 19107, USA. E-mail: ; Instagram: drlocketz
| | - Kirkland N Lozada
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Pennsylvania Health System, Philadelphia, PA
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Couto RA, Charafeddine A, Sinclair NR, Nayak LM, Zins JE. Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report. Aesthet Surg J 2020; 40:587-593. [PMID: 31504134 DOI: 10.1093/asj/sjz232] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. OBJECTIVES The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. METHODS Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors' protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. RESULTS Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). CONCLUSIONS Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output. Level of Evidence: 4.
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Affiliation(s)
- Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Ali Charafeddine
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Schroeder RJ, Langsdon PR. Effect of Local Tranexamic Acid on Hemostasis in Rhytidectomy. Facial Plast Surg Aesthet Med 2020; 22:195-199. [PMID: 32228311 DOI: 10.1089/fpsam.2020.0061] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Importance: Hematoma is the most common complication in rhytidectomy. Tranexamic acid (TXA) is an antifibrinolytic that may be a useful tool to reduce intraoperative bleeding and postoperative hematoma risk. Objective: To determine whether local TXA reduces intraoperative bleeding and postoperative drain output in rhytidectomy. Design, Setting, and Participants: Retrospective cohort study of patients undergoing deep plane rhytidectomy with platysmaplasty. Beginning January 1, 2019, we began adding 1 cc (100 mg) of TXA to every 10 cc of local anesthetic and tumescent solution. Patients were, therefore, separated into two cohorts: control and TXA. Primary outcomes include postoperative day 1 (POD1) drain output, days to drain removal, percentage drains removed POD1, and percentage POD1 drain output <25 cc. Secondary outcomes include minor hematoma, major hematoma, Nitro-bid use, intraoperative estimated blood loss (EBL), and thromboembolic events. Results: POD1 drain output reduced from 50.4 cc in control group versus 14.8 cc with TXA (p < 0.001). Average day of drain removal reduced from 1.8 days in control group versus 1.2 days with TXA (p = 0.001). Percentage of drains removed on POD1 was increased from 34.4% in control group to 77.3% with TXA (p < 0.001). Percentage of POD1 drain output <25 cc was increased from 21.9% in control group to 95.5% with TXA (p < 0.001). Intraoperative EBL <50 cc increased from 25% in control group to 75% with TXA (p < 0.001). No statistically significant difference was observed between control and TXA in rates of minor hematoma, major hematoma, Nitro-bid use, or thromboembolic events. Conclusions and Relevance: Local TXA used in rhytidectomy significantly reduces intraoperative blood loss, postoperative drain output, and time to drain removal. No significant difference was observed in postoperative complication rates.
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Affiliation(s)
- Ronald J Schroeder
- Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Phillip R Langsdon
- Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,The Langsdon Clinic, Germantown, Tennessee, USA
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Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic Review. Plast Reconstr Surg 2020; 145:669-684. [DOI: 10.1097/prs.0000000000006561] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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McGuire C, Nurmsoo S, Samargandi OA, Bezuhly M. Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty: A Systematic Review and Meta-analysis. JAMA FACIAL PLAST SU 2020; 21:191-198. [PMID: 30605219 DOI: 10.1001/jamafacial.2018.1737] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss. Objective To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty. Data Sources A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications. Study Selection The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included. Data Extraction and Synthesis The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size. Main Outcomes and Measures The primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. Results Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 (7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of -41.6 mL (95% CI, -69.8 to -13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high. Conclusions and Relevance Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty. Level of Evidence 4.
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Affiliation(s)
- Connor McGuire
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Nurmsoo
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Osama A Samargandi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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de Vasconcellos SJDA, do Nascimento-Júnior EM, de Aguiar Menezes MV, Tavares Mendes ML, de Souza Dantas R, Martins-Filho PRS. Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 144:816-823. [PMID: 30098161 DOI: 10.1001/jamaoto.2018.1381] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty. Objective To investigate the results of tranexamic acid use to reduce intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty. Data Sources and Study Selection For this systematic review of randomized clinical trials, searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017. Key words included tranexamic acid, rhinoplasty, and nasal surgical procedures. The following elements were used to define eligibility criteria: (1) population: patients undergoing rhinoplasty surgery; (2) intervention and controls: tranexamic acid vs placebo solution or no-treatment control group; (3) outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events; and (4) study type: randomized clinical trials. Data Extraction and Synthesis Two reviewers extracted data and assessed study quality according to the Cochrane guidelines for randomized clinical trials. Treatment effects were defined as weighted mean difference (WMD) and 95% CIs. The strength of evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation rating system. Main Outcomes and Measures Intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis. To calculate the effect sizes, means and SDs were obtained for each study group and outcome of interest. Results Five studies comprising 276 patients were included in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years. Four studies comprising 246 patients estimated the amount in intraoperative bleeding as a primary outcome and were included in the meta-analysis. Eyelid edema and ecchymosis were evaluated as outcomes in 2 studies. Tranexamic acid was associated with reduced bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P = .01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I2 = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I2 = 56%) administration. Eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08. No cases of thromboembolic events were reported. Conclusions and Relevance Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.
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Zaman SU, Zakir I, Faraz Q, Akhtar S, Nawaz A, Adeel M. Effect of single-dose intravenous tranexamic acid on postoperative nasal bleed in septoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:435-438. [PMID: 31204198 DOI: 10.1016/j.anorl.2018.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/22/2018] [Accepted: 10/07/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Postoperative nasal bleeding is a common complication of septoplasty and may lead to painful procedure of nasal packing to stop bleeding. Since Tranexamic acid (TXA) has been reported to reduce bleeding, the purpose of this study is to investigate the effect of single dose of intravenous TXA on postoperative nasal bleed associated with septoplasty. MATERIALS AND METHODS This prospective randomized, double-blinded clinical trial consisted of 176 patients aged 18-55 years who underwent septoplasty for symptomatic deviated nasal septum. These participants were randomly divided into 2 groups; 88 patients were given normal saline (Control group) and 88 patients were administered a single shot of intravenous TXA 10mg/kg (TXA group). Operative technique applied was same in all cases. At the end of surgery nasal packs, nasal splints or trans-septal suturing were not done. Nasal bleeding was monitored after surgery and up to 2 weeks postoperatively. RESULTS Patients receiving TXA showed significantly less postoperative nasal bleeding compared with controls. Extensive bleeding in terms of number of gauze pads used and duration was also higher in placebo with a statistically significant difference (all P=<0.05). Seven patients required nasal packing in control group to stop bleeding as compared to one patient in TXA group. Adverse reactions to TXA were minimal, and these were easily managed conservatively. CONCLUSION Single intravenous dose of TXA is shown to be effective and safe agent in preventing postoperative nasal bleeding after septoplasty therefore avoiding additional techniques of nasal packing, intranasal splint or trans-septal suturing during surgery.
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Affiliation(s)
- S U Zaman
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.
| | - I Zakir
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Q Faraz
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - S Akhtar
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - A Nawaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - M Adeel
- Department of Head & Neck Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
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Wang N, Xiong X, Xu L, Ji M, Yang T, Tang J, Yang Y, Liu W, Chen H. Transfusions and cost-benefit of oral versus intravenous tranexamic acid in primary total hip arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e15279. [PMID: 31027085 PMCID: PMC6831163 DOI: 10.1097/md.0000000000015279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/18/2019] [Accepted: 03/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the cost benefit and transfusions of oral and IV tranexamic acid (TXA) in primary total hip arthroplasty (THA). METHODS PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing oral and IV TXA in primary THA. Primary outcomes were total blood loss, maximum hemoglobin drop, transfusion requirements, and cost benefit. Secondary outcomes were length of stay, deep venous thrombosis (DVT) and/or pulmonary embolism (PE). RESULTS Four independent RCTs were included involving 391 patients. There was no difference in the total blood loss (P = .99), maximum hemoglobin drop (P = .73), and the length of stay (P = .95) between the 2 groups. Transfusion requirements (P = .97) were similar. The total mean cost was the US $75.41 in oral TXA group and the US $580.83 in IV TXA group. The incidence of DVT (P = .3) did not differ significantly between the 2 groups, and no PE was reported in all studies. CONCLUSION Oral TXA shows similar efficacy and safety as IV TXA in reducing total blood loss, maximum hemoglobin drop and transfusion requirements in primary THA. However, oral TXA may be more cost-benefit than IV TXA. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Ning Wang
- Department of Orthopedics Joint Disease Area
| | | | - Lixin Xu
- Department of Orthopedics Joint Disease Area
| | - Ming Ji
- Department of Orthopedics Joint Disease Area
| | - Tao Yang
- Department of Orthopedics Joint Disease Area
| | - Jin Tang
- Department of Orthopedics Joint Disease Area
| | - Yong Yang
- Department of Orthopedics Joint Disease Area
| | - Wangwei Liu
- Department of Orthopedics Joint Disease Area
| | - Hongxia Chen
- Department of Pediatric, Chongqing Three Gorges Central Hospital, Wanzhou, Chongqing. PR China
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Ping WD, Zhao QM, Sun HF, Lu HS, Li F. Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial. Medicine (Baltimore) 2019; 98:e15202. [PMID: 31008946 PMCID: PMC6494350 DOI: 10.1097/md.0000000000015202] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Nasal surgeries (such as Functional Endoscopic Sinus Surgery, Rhinoplasty, and Septorhinoplasty) are popular procedures. But perioperative bleeding, eyelid edema, and periorbital ecchymosis remain problems. Tranexamic acid (TXA) is an antifibrinolytic, and it was used to reduce the perioperative bleeding. However, there is no enough evidence judging its safety and efficiency. Therefore, a meta-analysis is conducted by us to evaluate the role of TXA in patients undergoing nasal surgeries. METHOD A search of the literature was performed until June 2018; the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. Only randomized controlled trial (RCT) articles were included, and subgroup analysis was established to deal with heterogeneity. RevMan 5.3 software was selected to conduct the meta-analysis. RESULT Eleven RCTs were included in our meta-analysis. There were significant differences in blood loss (P < .001), surgical field quality (P < .001), edema rating of upper (P < .001) and lower (P < .001) eyelid, ecchymosis rating of upper (P < .001) and lower eyelid (P < .001) when comparing the TXA group to the placebo group. However, the difference in operation time (P = .57) was not significant between the two groups. CONCLUSION Perioperative TXA could reduce the blood loss and improve the quality of surgery field during nasal surgery, and it was helpful for reducing the edema and ecchymosis after nasal surgeries, but it has little influence in reducing the operation time.
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Affiliation(s)
- Wei-dong Ping
- Department of Plastic and Reconstructive Surgery, Zhejiang Hospital
| | - Qi-ming Zhao
- Department of Plastic and Reconstructive Surgery, Zhejiang Hospital
| | - Hua-feng Sun
- Department of Plastic and Reconstructive Surgery, 903th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Hai-shan Lu
- Department of Plastic and Reconstructive Surgery, 903th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Fei Li
- Department of Plastic and Reconstructive Surgery, Zhejiang Hospital
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Siotou K, Siotos C, Azizi A, Cheah MA, Seal SM, Redett RJ, Rosson GD. The Role of Antifibrinolytics in Reducing Blood Loss During Craniofacial or Orthognathic Surgical Procedures: A Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1245-1260. [PMID: 30796910 DOI: 10.1016/j.joms.2019.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Use of antifibrinolytic drugs in craniofacial and orthognathic surgery seems quite promising and has strong advocates. However, supporting evidence is controversial and limited by a small sample of individual studies. We sought to systematically review and meta-analyze the available data regarding the role of preoperative or intraoperative antifibrinolytic drugs (eg, tranexamic acid, aprotinin, or aminocaproic acid) in craniofacial and orthognathic surgery. MATERIALS AND METHODS We searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science through April 19, 2018, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes of interest included the volume of blood loss, volume of transfusions, and operative time. A meta-analysis was performed with a random-effects model using Review Manager (RevMan) software (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS We identified 32 eligible studies with 749 patients undergoing craniofacial surgery and 546 undergoing orthognathic surgery. Meta-analysis showed that antifibrinolytic use led to statistically significant decreases in blood loss and blood transfusions for craniofacial procedures in adult or pediatric patients and to significantly less blood loss during orthognathic surgical procedures. Operative time did not significantly differ for either type of surgery. CONCLUSIONS Antifibrinolytics can significantly reduce blood loss in craniofacial surgical procedures including pediatric craniosynostosis and adult rhinoplasties and in orthognathic surgical procedures, as well as transfusion requirements in pediatric craniofacial surgical procedures. However, the clinical significance of the medications is still questionable because of the relative paucity of information on adverse effects and the usual small volume loss during those operations.
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Affiliation(s)
- Kalliopi Siotou
- Research Fellow, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Siotos
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD.
| | - Armina Azizi
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| | - Michael A Cheah
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD; and Resident, Inova Fairfax Medical Campus, Falls Church, VA
| | - Stella M Seal
- Associate Director, Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Richard J Redett
- Professor, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| | - Gedge D Rosson
- Associate Professor, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
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Joseph J, Martinez‐Devesa P, Bellorini J, Burton MJ. Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev 2018; 12:CD004328. [PMID: 30596479 PMCID: PMC6517002 DOI: 10.1002/14651858.cd004328.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epistaxis (nosebleed) most commonly affects children and the elderly. The majority of episodes are managed at home with simple measures. In more severe cases medical intervention is required to either cauterise the bleeding vessel, or to pack the nose with various materials. Tranexamic acid is used in a number of clinical settings to stop bleeding by preventing clot breakdown (fibrinolysis). It may have a role in the management of epistaxis as an adjunct to standard treatments, reducing the need for further intervention. OBJECTIVES To determine the effects of tranexamic acid (oral, intravenous or topical) compared with placebo, no additional intervention or any other haemostatic agent in the management of patients with epistaxis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register (via CRS Web); Central Register of Controlled Trials (CENTRAL) (via CRS Web); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 29 October 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) of tranexamic acid (in addition to usual care) compared with usual care plus placebo, usual care alone or usual care plus any other haemostatic agent, to control epistaxis in adults or children. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were control of epistaxis: re-bleeding (as measured by the proportion of patients re-bleeding within a period of up to 10 days) and significant adverse effects (seizures, thromboembolic events). Secondary outcomes were control of epistaxis as measured by the time to stop initial bleeding (the proportion of patients whose bleeding is controlled within a period of up to 30 minutes); severity of re-bleeding (as measured by (a) the proportion of patients requiring any further intervention and (b) the proportion of patients requiring blood transfusion); length of hospital stay and other adverse effects. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included six RCTs (692 participants). The overall risk of bias in the studies was low. Two studies assessed oral administration of tranexamic acid, given regularly over several days, and compared it to placebo. In the other four studies, a single application of topical tranexamic acid was compared with placebo (one study) and a combination of epinephrine and lidocaine or phenylephrine (three studies). All participants were adults.Tranexamic acid versus placeboFor our primary outcome, control of epistaxis: re-bleeding (proportion re-bleeding within 10 days), we were able to pool data from three studies. The pooled result demonstrated a benefit of tranexamic acid compared to placebo, the risk of re-bleeding reducing from 67% to 47% (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.56 to 0.90; three studies; 225 participants; moderate-quality evidence).When we compared the effects of oral and topical tranexamic acid separately the risk of re-bleeding with oral tranexamic acid reduced from 69% to 49%, RR 0.73 (95% CI 0.55 to 0.96; two studies, 157 participants; moderate-quality evidence) and with topical tranexamic acid it reduced from 66% to 43%, RR 0.66 (95% CI 0.41 to 1.05; single study, 68 participants). We rated the quality of evidence provided by the single study as low, therefore it is uncertain whether topical tranexamic acid is effective in stopping bleeding in the 10-day period after a single application.No study specifically sought to identify and report our primary outcome: significant adverse effects (i.e. seizures, thromboembolic events).The secondary outcome time to stop initial bleeding (proportion with bleeding controlled within 30 minutes) was measured in one study using topical tranexamic acid and there was no evidence of a difference at 30 minutes (RR 0.79, 95% CI 0.56 to 1.11; 68 participants; low-quality evidence).No studies reported the proportion of patients requiring any further intervention (e.g. repacking, surgery, embolisation).One study of oral tranexamic acid reported the proportion of patients requiring blood transfusion and found no difference between groups: 5/45 (11%) versus 6/44 (14%) (RR 0.81, 95% CI 0.27 to 2.48; 89 participants; low-quality evidence).Two studies reported hospital length of stay. One study reported a significantly shorter stay in the oral tranexamic acid group (mean difference (MD) -1.60 days, 95% CI -2.49 to -0.71; 68 participants). The other study found no evidence of a difference between the groups.Tranexamic acid versus other haemostatic agentsWhen we pooled the data from three studies the proportion of patients whose bleeding stopped within 10 minutes was significantly higher in the topical tranexamic acid group compared to the group receiving another haemostatic agent (70% versus 30%: RR 2.35, 95% CI 1.90 to 2.92; 460 participants) (moderate-quality evidence).Adverse effects across all studiesFive studies recorded 'adverse effects' in a general way. None found any difference between the groups in the occurrence of minor adverse effects (e.g. mild nausea and diarrhoea, 'bad taste' of gel). In one study a patient developed a superficial thrombophlebitis of both legs following discharge, however it is not reported in which group this occurred. No "other serious adverse effect" was reported in any study. AUTHORS' CONCLUSIONS We found moderate-quality evidence that there is probably a reduction in the risk of re-bleeding with the use of either oral or topical tranexamic acid in addition to usual care in adult patients with epistaxis, compared to placebo with usual care. However, the quality of evidence relating solely to topical tranexamic acid was low (one study only), so we are uncertain whether or not topical tranexamic acid is effective in stopping bleeding in the 10-day period after a single application. We found moderate-quality evidence that topical tranexamic acid is probably better than other topical agents in stopping bleeding in the first 10 minutes.There have been only three RCTs on this subject since 1995. Since then there have been significant changes in nasal cauterisation and packing techniques (for example, techniques including nasal endoscopy and more invasive approaches such as endoscopic sphenopalatine artery ligation). New trials would inform us about the effectiveness of tranexamic acid in light of these developments.
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Affiliation(s)
- Jonathan Joseph
- Royal National Throat, Nose and Ear Hospital330 Gray's Inn RoadLondonUKWC1X 8DA
| | | | - Jenny Bellorini
- Nuffield Department of Surgical Sciences, University of OxfordCochrane ENTc/o Cochrane UK18 Middle WayOxfordUKOX2 7LG
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
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Yates J, Perelman I, Khair S, Taylor J, Lampron J, Tinmouth A, Saidenberg E. Exclusion criteria and adverse events in perioperative trials of tranexamic acid: a systematic review and meta-analysis. Transfusion 2018; 59:806-824. [PMID: 30516835 DOI: 10.1111/trf.15030] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) is an inexpensive therapy effective at minimizing perioperative blood loss and transfusion. However, it remains underutilized due to safety concerns. To date, no evidence-based guidelines exist identifying which patients should not receive TXA therapy. This study determined patient groups for whom safety information regarding TXA is lacking due to common exclusion from perioperative TXA trials. STUDY DESIGN AND METHODS A systematic review searching the databases Medline, EMBASE, CENTRAL, and Clinicaltrials.gov was performed. Randomized controlled trials (RCTs) administering systemic TXA perioperatively to elective or emergent surgery patients were eligible. Our primary outcome was to describe exclusion criteria of RCTs, and the secondary outcome was TXA safety. A descriptive synthesis of exclusion criteria was performed, and TXA safety was assessed by meta-analysis. RESULTS A total of 268 eligible RCTs were included. Meta-analysis showed that systemic TXA did not increase risk of adverse events compared to placebo or no intervention (relative risk, 1.05; 95% confidence interval, 0.99-1.12). Patient groups commonly excluded from perioperative TXA trials, and thus potentially lacking TXA safety data, were those with major comorbidities, a history of thromboembolism, medication use affecting coagulation, TXA allergy, and coagulopathy. Exclusion of patients with major comorbidities may not be necessary; we showed that the risk of adverse events was similar in studies that excluded patients with major comorbidities and those that did not. CONCLUSION Sufficient evidence exists to develop perioperative guidelines for TXA use in many populations. Further studies evaluating perioperative TXA use in patients with a history of thromboembolism are warranted.
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Affiliation(s)
- Jeffrey Yates
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Iris Perelman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simonne Khair
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Taylor
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacinthe Lampron
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elianna Saidenberg
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
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Antifibrinolytic Agents in Plastic Surgery: Current Practices and Future Directions. Plast Reconstr Surg 2018; 141:937e-949e. [PMID: 29794717 DOI: 10.1097/prs.0000000000004421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and ε-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations. METHODS A systematic review of the PubMed, Cochrane, and Google Scholar databases was conducted for publications examining the use of antifibrinolytics in plastic surgery. Studies were abstracted for procedure type, antifibrinolytic dose, time and mode of administration, blood loss, transfusion requirements, and complications. RESULTS Thirty-three studies were deemed eligible for inclusion, comprising a total of 1823 patients undergoing plastic surgical procedures with tranexamic acid (n = 1328) and/or ε-aminocaproic acid (n = 495). CONCLUSIONS Tranexamic acid and ε-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.
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The Role of Tranexamic Acid in Plastic Surgery: Review and Technical Considerations. Plast Reconstr Surg 2018; 141:507-515. [PMID: 28938364 DOI: 10.1097/prs.0000000000003926] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Minimizing blood loss during surgery is critical, and many modalities have been used to decrease unwanted surgical bleeding. Among many methods, use of pharmacologic agents such as antifibrinolytic drugs has been shown to significantly reduce blood loss and the rates of postoperative blood transfusion in many articles. Tranexamic acid is an antifibrinolytic agent that has been widely used in other surgical specialties, especially in cardiac, orthopedic, and trauma surgery. Despite its known benefits, the use of tranexamic acid in plastic surgery is extremely limited, primarily because most plastic surgery procedures do not involve the extent of blood loss that can lead to anemia and the need for blood transfusion, as is common in major orthopedic and cardiac surgery procedures. Nevertheless, there are significant benefits to be gained from the use of antifibrinolytic drugs in the full range of plastic surgery. In this article, the authors introduce the benefits, dosages, and technical considerations of using tranexamic acid in plastic surgery procedures.
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Mehdizadeh M, Ghassemi A, Khakzad M, Mir M, Nekoohesh L, Moghadamnia A, Bijani A, Mehrbakhsh Z, Ghanepur H. Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis. Aesthetic Plast Surg 2018; 42:246-252. [PMID: 28980055 DOI: 10.1007/s00266-017-0969-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. METHODS A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups. RESULTS In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT. CONCLUSION Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mohammad Mehdizadeh
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Ghassemi
- Consultant Oral and Maxillofacial Surgeon, Klinikum Lippe, Academic Hospital of the University of Göttingen, Detmold, Germany
- Medical Faculty University RWTH Aachen, Aachen, Germany
| | - Mohammad Khakzad
- Department of Plastic Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mehrafza Mir
- Department of Anesthesiology and Intensive Care, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Leili Nekoohesh
- Department of Medical Biotechnology, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Moghadamnia
- Department of Pharmacology and Toxicology, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Mehrbakhsh
- Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hosein Ghanepur
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.
- Department of Oral and Maxillofacial Surgery, 5 Azar Hospital, Golestan University of Medical Sciences, 5 Azar Street, Gorgan, Iran.
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50
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Li GL, Li YM. Oral tranexamic acid can reduce blood loss after total knee and hip arthroplasty: A meta-analysis. Int J Surg 2017; 46:27-36. [PMID: 28797918 DOI: 10.1016/j.ijsu.2017.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/16/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the efficacy and safety of oral tranexamic acid (TXA) with controls or intravenous TXA in patients undergoing total joint arthroplasty (TJA) in a systematic review and meta-analysis. METHODS We systematically searched randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google databases. Any studies comparing oral TXA versus a control group or intravenous TXA for patients prepared for TJA were included. The outcomes included the need for transfusion, hemoglobin drops, length of hospital stay and drain volume. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for the need of transfusion and the weighted mean difference (WMD) with a 95% CI for hemoglobin drop, length of hospital stay and drain blood loss. Stata 12.0 was used for the meta-analysis. RESULTS Five clinical trials (5 RCTs) involving 333 patients were finally included in this meta-analysis. When compared with the control group, oral TXA was associated with less need for transfusion, fewer hemoglobin drops, less drain volume and a shorter length of hospital stay (P < 0.05). When compared with IV TXA, oral TXA was associated with more hemoglobin drops (P < 0.05). However, there was no significant difference between the need for transfusion, drain volume and the length of hospital stay between oral TXA and IV TXA. CONCLUSION Oral TXA has comparable hemostatic effects with IV TXA and may reduce the costs for patients prepared for TJA. However, considering the limited quality and number of the included studies, more high-quality and multi-center RCTs are still needed to recommend oral TXA for routine administration.
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Affiliation(s)
- Guang-Lei Li
- Department of Orthopedic, Linzi District People's Hospital, Zibo, Shandong, 255400, China; Clinical Laboratory Linzi District People's Hospital, Zibo, Shandong, 255400, China
| | - Yong-Mei Li
- Department of Orthopedic, Linzi District People's Hospital, Zibo, Shandong, 255400, China; Clinical Laboratory Linzi District People's Hospital, Zibo, Shandong, 255400, China.
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