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Mizutani A, Sanuki T, Kido K. Effectiveness of tranexamic acid on intra- and postoperative bleeding in Bimaxillary osteotomies: a retrospective study. Oral Maxillofac Surg 2024:10.1007/s10006-024-01288-1. [PMID: 39225893 DOI: 10.1007/s10006-024-01288-1] [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: 02/28/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Perioperative bleeding is a serious concern during orthognathic surgery. Tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic properties, reduces blood loss across various surgical fields. This study aimed to investigate the effectiveness of preoperative TXA administration in reducing intraoperative and postoperative blood loss following combined Le Fort I and sagittal split ramus osteotomies at our hospital. METHODS This single-center, retrospective cohort study included patients who underwent combined Le Fort I and sagittal split ramus osteotomies between November 2017 and October 2022. The primary outcome was the volume of intraoperative blood loss. RESULTS Among 1,329 eligible patients, 87 were included in the analysis (32 in the TXA group and 55 in the control group, where no TXA was administered). The median (interquartile range) intraoperative blood loss was 200.0 (157.5-237.5) mL in the TXA group and 260.0 (180.0-350.0) mL in the control group, showing a significant difference between the groups (p = 0.0365). However, postoperative blood drainage within 24 h and 24-48 h did not differ significantly between the two groups. CONCLUSION A single intravenous administration of TXA was associated with a decrease in intraoperative bleeding without severe adverse events during combined Le Fort I and sagittal split ramus osteotomies. However, postoperative blood loss, nausea, vomiting, and autologous blood transfusion were not significantly associated with this administration.
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Affiliation(s)
- Ayako Mizutani
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Kanta Kido
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Kita-13, Nishi-7, Kita-ku, Sapporo, 060-8586, Hokkaido, Japan.
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Mortada H, Hussain SA, Liyanage DD, Zou Y, Subbiah P, George J, Mansour HRK, Khajuria A. Does tranexamic acid really matter in reducing blood loss? A critical evaluation of its efficacy in orthognathic surgery through a comprehensive systematic review and meta-analysis. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00176-1. [PMID: 39266337 DOI: 10.1016/j.bjoms.2024.06.011] [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: 12/16/2023] [Accepted: 06/29/2024] [Indexed: 09/14/2024]
Abstract
Tranexamic acid (TXA) is acknowledged for reducing blood loss and transfusion requirements in various surgical specialties, yet its role in orthognathic procedures is less defined. Our study seeks to fill this knowledge gap by reviewing the available data and summarising the efficacy and clinical outcomes of TXA in orthognathic surgery. We performed a systematic review and meta-analysis, searching five databases for studies until 16 April, 2023. Our key outcome measures were intraoperative blood loss, postoperative bleeding, and transfusion rate. Previous weaknesses in systematic review and meta-analyses (SRMA) were identified using Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). The risk of bias was evaluated with the RoB-2 tool. A total of 15 studies were included, involving a combined total of 1060 patients. Compared with the control, the TXA group demonstrated significant reductions in intraoperative blood loss (mean difference -135.60 mL; p < 0.00001; 95% CI, -177.51 to -93.70 mL), Hb level drop (mean difference: 2.67 [-0.63, 5.98]), and improved surgical field visibility [p < 0.00001. (MD -0.99) (CI -1.11 to -0.86)]. No significant differences were observed in postoperative haematocrit levels (mean difference: -0.42 [-2.19, 1.35]; p = 0.003; I2 = 75%), operation duration (p = 0.21), or duration of hospital stay (p = 0.63) between TXA and control groups. In orthognathic surgery, TXA effectively minimises blood loss, demonstrating both safety and efficiency. Well-designed, larger studies and comparisons with other haemostatic agents could solidify TXA evidence.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh Saudi Arabia.
| | | | | | - Yutong Zou
- Hope College, Holland, MI, United States.
| | - Praveen Subbiah
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, United Kingdom.
| | - Jefferson George
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, England.
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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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Grillo R, Reis BAQ, Brozoski MA, Traina AA, Melhem-Elias F. Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101639. [PMID: 37729964 DOI: 10.1016/j.jormas.2023.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery. METHODS The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery. RESULTS This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted. CONCLUSION Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil
| | - Andreia Aparecida Traina
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil
| | - Fernando Melhem-Elias
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Private Practice in São Paulo-SP, Brazil
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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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Wang S, Yang J, Lin L. Intravenous Application of Tranexamic Acid in Patients Undergoing Plastic Surgery: A Systematic Review and Meta-analysis with GRADE Quality Assessment. Aesthetic Plast Surg 2024; 48:543-558. [PMID: 37721624 DOI: 10.1007/s00266-023-03637-z] [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: 05/15/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is a versatile antifibrinolytic agent that is widely used in modern surgeries. This review assessed the safety and efficacy of intravenous (IV) TXA in plastic surgery versus controls. METHODS This review selected English-language Randomized controlled trials (RCTs) evaluating IV TXA effects in plastic surgery from four electronic databases, PubMed, Web of Science, Embase, and Cochrane Library up to April 9, 2023. Primary outcomes were blood loss volume (BLV) and transfusion occurrence, with operation time and surgical field assessment as secondary outcomes. IV TXA-related complications were also important indicators. Meta-analyses and qualitative analyses were conducted and the quality of the evidence was assessed. RESULTS Thirty RCTs with 2150 patients were included. The total standard mean difference (SMD) of BLV and pooled relative risk of transfusion occurrence between the IV TXA and the control groups were - 1.11 (95% CI, - 1.42 to - 0.80) and 0.36 (95% CI, 0.23 to 0.55) respectively, indicating a significant blood loss reduction with IV TXA treatment, while an ambiguous outcome of operation time was observed, with an SMD of - 0.22 (95% CI, - 0.42 to - 0.02). The quality of evidence for BLV and transfusion occurrence was low and medium, respectively. A quantitative analysis of surgical field assessment was not performed because of the substantial heterogeneity in scoring methods. No IV TXA-related complications were observed. CONCLUSIONS In plastic surgery, IV TXA administration results in less blood loss, reduced need for transfusion and better surgical fields but probably does not increase the risk of adverse events. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Senmao Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jingwen Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Lin Lin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Ahmadi MS, Jahanshahi J, Hashemian F, Salimbahrani AR, Haghi N, Khanlarzadeh E. Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2023; 35:49-56. [PMID: 36721414 PMCID: PMC9872265 DOI: 10.22038/ijorl.2022.64361.3203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/26/2022] [Indexed: 02/02/2023]
Abstract
Introduction The quality of the surgical field during the surgery is impaired when bleeding occurs. This study compared the effect of tranexamic acid and dexmedetomidine on the rate of bleeding during endoscopic sinus surgery (ESS). Materials and Methods In this one-blind clinical trial, 72 patients with chronic rhinosinusitis who were candidates for ESS at Be'sat Hospital in Hamedan were randomly assigned to two groups. Group A received dexmedetomidine at a dose of 1μg/kg, and group B received tranexamic acid at a dose of 10mg/kg immediately after induction of anesthesia intravenously within 15 minutes. The two groups were evaluated and compared regarding the quality of the surgery field with the Boezaart scale, volume of intraoperative bleeding, hemodynamic changes, and complications up to 90 minutes after the beginning of surgery. Results The mean volume of intraoperative bleeding in group A (181.67±86.66) was significantly higher than in group B (110.28±61.23) (P =0.000). At 15, 30, and 60 minutes, the quality of the surgical field in group B was better than group A (P =0.038), while at 90 minutes, there was no statistically significant difference (P =0.450). The mean arterial pressure in group A at 15 minutes was higher than in group B (P=0.003); at 60 and 90 minutes, it was lower, and the difference was statistically significant (P =0.01). On the other hand, in 30 minutes, the mean arterial pressure in group A was higher than in group B, without a significant difference (P =0.07). Moreover, there was no statistically significant difference between the average surgery time (P = 0.25) and the frequency of complications (P =0.405). Conclusions Based on the results, tranexamic acid is preferable to injectable dexmedetomidine to control and reduce bleeding during ESS.
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Affiliation(s)
- Mohammad Saeed Ahmadi
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Javaneh Jahanshahi
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farnaz Hashemian
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran.
| | | | - Negar Haghi
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran.,Corresponding Author: Department of Otolaryngology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
| | - Elham Khanlarzadeh
- Department of Social Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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Novel Use of Tranexamic Acid to Reduce Time Taken During Bracket Placement for Orthodontic Traction of Impacted Teeth: An Observational Study. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bendersky J, Uribe M, Bravo M, Vargas JP, Flores E, Aguero I, Villanueva J, Urrutia G, Bonfill X. Systematic mapping review of orthognathic surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e285-e305. [PMID: 35568120 DOI: 10.1016/j.jormas.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
STUDY DESIGN Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.
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Affiliation(s)
- Josefina Bendersky
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Macarena Uribe
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Maximiliano Bravo
- Oral and Maxillofacial Surgery Program, Universidad de los Andes, Santiago, Chile.
| | - Juan Pablo Vargas
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Enrique Flores
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Ignacio Aguero
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery and Cochrane Associated Center at Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile.; Servicio de Cirugía Maxilofacial. Hospital Clínico San Borja-Arriarán. Sta. Rosa 1234, Santiago, Región Metropolitana, Chile.
| | - Gerard Urrutia
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Xavier Bonfill
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
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Jozefowicz E, Sabourdin N, Lambelin V, Lejeune V, Delassus R, Tavernier B. The effect of tranexamic acid on blood loss in orthognathic surgery: a randomized, placebo-controlled, equivalence study. Int J Oral Maxillofac Surg 2021; 51:637-642. [PMID: 34465477 DOI: 10.1016/j.ijom.2021.08.018] [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: 02/08/2021] [Revised: 06/01/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Orthognathic surgery can cause substantial bleeding. Recent meta-analyses concluded that there is a statistically significant reduction in perioperative blood loss with the preventive use of tranexamic acid (TA). However, the mean reported difference in bleeding was moderate, and the clinical relevance of this blood-sparing effect remains debated. We therefore conducted a prospective, double-blind, randomized, placebo-controlled equivalence study of the effect of TA in patients undergoing Lefort I or bimaxillary osteotomies. Our main outcome measure was total blood loss on postoperative day 1. The equivalence margin was ± 250 ml for the difference in blood loss and its 95% confidence interval. One hundred and forty-seven patients were randomized, of which 122 underwent bimaxillary osteotomies. Blood loss in the treatment group was 682 ± 323 vs. 875 ± 492 ml. The mean difference in bleeding was -132 [-243; -21] ml as per-protocol, but -193 [-329; -57] ml in intention-to-treat: the limits of this confidence interval exceeded the margin of equivalence. Similar results were obtained when analysing only patients undergoing bimaxillary osteotomy. Haemoglobin decreased by 1.8 ± 1.2 g/dl with TA, vs. 2.6 ± 1.1 g/dl with placebo (p<0.001). Our study did not demonstrate equivalence between TA and placebo on perioperative blood loss in orthognathic surgery. TA may reduce blood loss but without evidence of clinical consequences.
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Affiliation(s)
- E Jozefowicz
- CHU Lille, Pôle d'Anesthésie-Réanimation, F-59000 Lille, France.
| | - N Sabourdin
- Department of Anesthesiology, Armand Trousseau University Hospital, DMU DREAM, APHP, GRC 29, Sorbonne Université, Paris, France
| | - V Lambelin
- CHU Lille, Pôle d'Anesthésie-Réanimation, F-59000 Lille, France
| | - V Lejeune
- CHU Lille, Pôle d'Anesthésie-Réanimation, F-59000 Lille, France
| | - R Delassus
- CHU Lille, Pôle d'Anesthésie-Réanimation, F-59000 Lille, France
| | - B Tavernier
- CHU Lille, Pôle d'Anesthésie-Réanimation, F-59000 Lille, France; Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, F-59000 Lille, France
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11
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Fu R, Liu C, Yan Y, Suo L, Xie Y, Li Q, Huang RL. Tranexamic Acid in Craniomaxillofacial Surgery: A Meta-Analysis and Systematic Review. Facial Plast Surg Aesthet Med 2021; 23:422-429. [PMID: 33661026 DOI: 10.1089/fpsam.2020.0590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To compare the effectiveness of tranexamic acid (TXA) in reducing blood loss and decreasing surgery duration in craniomaxillofacial surgery. Methods: The literature was searched systematically for all comparative studies of the effect of TXA on craniomaxillofacial surgery with placebo to evaluate the efficacy of TXA in craniomaxillofacial surgery. The primary outcome was intraoperative blood loss, and secondary outcomes were postoperative hematocrit, postoperative hemoglobin, and operation duration. Results: This systematic review included 16 studies consisting of 958 patients. Meta-analysis revealed that compared with the placebo group, the TXA group showed a significant reduction in intraoperative blood loss of 139.81 mL (95% confidence interval, CI: -179.66 to -99.96 mL; p < 0.01), a shortening of the maxillary surgery duration of 15.48 min (95% CI: -21.03 to -9.92 min; p < 0.01), an elevation of the postoperative hemoglobin level of 0.74 mg/dL (95% CI: 0.42 to 1.07 mg/dL; p < 0.01), and a limited effect on increasing the postoperative hematocrit level of 1.77% (95% CI: 0.17 to 3.36; p = 0.03). Conclusion: The use of TXA in craniomaxillofacial surgery can effectively reduce intraoperative blood loss, maintain elevate postoperative hemoglobin and hematocrit levels, and reduce the operation duration.
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Affiliation(s)
- Rao Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanqi Liu
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxin Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlang Suo
- Department of Surgery, Shanghai Eighth People's Hospital, Shanghai, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Sun L, Guo R, Feng Y. Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery. Plast Surg (Oakv) 2020; 28:94-104. [PMID: 32596184 DOI: 10.1177/2292550320925897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = -264.82 mL; 95% CI: -380.60 to -149.04 mL) and decreased amounts of irrigation fluid (WMD = -229.23 mL; 95% CI: -399.63 to -58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = -8.71 min; 95% CI: -20.98 to 3.57 min), and length of hospital stay (WMD = -0.24 day; 95% CI: -0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.
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Affiliation(s)
- Liang Sun
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Rui Guo
- Editorial Department of National Medical Journal of China, Chinese Medical Journals Publishing House, Chinese Medical Association, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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13
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Sharma H, Arora S, Bhatia N, Rattan V, Sethi S. Tranexamic Acid Is Associated With Improved Operative Field in Orthognathic Surgery. J Oral Maxillofac Surg 2020; 78:1509-1517. [PMID: 32497489 DOI: 10.1016/j.joms.2020.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE In the past, both tranexamic acid and dexmedetomidine have been used separately to decrease intraoperative blood loss during orthognathic surgery. However, their combined use in the same setting has never been prospectively evaluated. The present study was conducted to evaluate the effect of tranexamic acid on operative field visibility and blood loss during orthognathic surgery after dexmedetomidine-induced hypotensive anesthesia. PATIENTS AND METHODS The present prospective, randomized clinical trial included patients who had undergone orthognathic surgery under general anesthesia. The patients were divided into 2 groups. The dexmedetomidine and tranexamic (DT) group received an intravenous bolus of tranexamic acid (15 mg/kg) and intravenous dexmedetomidine (0.25 to 0.7 μg/kg/hr) as maintenance infusion. The dexmedetomidine (DS) group received only intravenous dexmedetomidine at the same dosage. All the patients received a bolus dose of intravenous dexmedetomidine (1 μg/kg) before the start of anesthesia induction. The operating surgeon rated the quality of the surgical visual field every 15 minutes using the Fromme ordinal scale. Intraoperative blood loss was estimated using the modified gross formula. The operating surgeon's satisfaction was assessed using a Likert scale. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). Kolmogorov-Smirnov tests were used to assess the normality of the measured data, and categorical variables were analyzed using the χ2 or Fischer exact test. RESULTS The study sample included 36 patients, with a mean age of 23.67 ± 11.298 years in the DS group and 20.28 ± 3.286 years in the DT group. Of the patients in the DS and DT groups, 66.66 and 61.11% were male, respectively. No statistically significant differences were found in the baseline characteristics between the 2 treatment groups. The surgeon reported a significantly better surgical visual field in the DT group compared with that in the DS group (P = .001). Also, the intraoperative blood loss significantly less in the DT group (231.11 ± 137.64 mL vs 360.17 ± 187.86 mL; P = .025). CONCLUSIONS Tranexamic acid improved surgical field visibility and reduced intraoperative blood loss when administered in conjunction with dexmedetomidine during orthognathic surgery under controlled hypotensive anesthesia.
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Affiliation(s)
- Harjinder Sharma
- Junior Resident, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suman Arora
- Professor, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Bhatia
- Additional Professor, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vidya Rattan
- Additional Professor, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Professor, Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Yao RZ, Gao WQ, Wang BW, Wang GL, Wu CX, A-Mu YD. Efficacy and Safety of Tranexamic Acid in Reducing Blood Loss of Lower Extremity Osteotomy in Peri-acetabulum and High Tibia: A Systematic Review and Meta-analysis. Orthop Surg 2020; 11:545-551. [PMID: 31456323 PMCID: PMC6712373 DOI: 10.1111/os.12515] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/19/2019] [Accepted: 07/18/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To assess the efficacy of tranexamic acid (TXA) in reducing total blood loss and transfusion, and the risk of thromboembolic events in patients undergoing periacetabular osteotomy (PAO) and high tibial osteotomy (HTO). Methods A systematic literature search was performed using PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase (Ovid), Medline (Ovid), and Web of Science. ClinicalTrials.gov, American Academy of Orthopaedic Surgeons (AAOS), and Orthopaedic Trauma Association (OTA) conference proceedings were also searched to gain more eligible studies. The primary outcome measure was total blood loss and the blood transfusion rate of the TXA group versus control. The meta‐analysis was conducted using the RevMan 5.3 and Stata 14.0 software. Results A total of six studies were included involving 665 patients. Three studies were PAO, and the other three were HTO. The total blood loss in PAO (WMD, −330.49; 95% CI, −390.16 to −270.83; P < 0.001) and HTO (WMD, −252.50; 95% CI, −356.81 to −148.18; P < 0.001) and hemoglobin decline (WMD, −0.74; 95% CI, −1.09 to −0.38; P < 0.001) were significantly less in the TXA group than in the control group. TXA could reduce transfusion rates in PAO (RR, 0.26; 95% CI, 0.09 to 0.75; P = 0.01) but had no effect on HTO (RR, 0.20; 95% CI, 0.01 to 4.10; P = 0.30). The wound complications (RR, 0.62; 95% CI, 0.13 to 2.94; P = 0.54) had no significant difference between TXA and control groups. Conclusions This meta‐analysis demonstrated that TXA reduces total blood loss and hemoglobin decline in patients undergoing PAO and is safe, but it has little benefit in regard to reducing transfusion rates or wound complications in HTO, so TXA might be unwarranted for routine use for HTO.
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Affiliation(s)
- Ru-Zhan Yao
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Qiang Gao
- Deparment of Orthopedics, Chengdu Integrated Traditional Chinese and Western Medicine Hospital, The First People's Hospital of Chengdu Sichuan Province, Sichuan Sheng, China
| | - Bing-Wu Wang
- Department of Spinal Surgery, Weifang People's Hospital, Weifang, China
| | - Guang-Lin Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.,Deparment of Orthopedics, The People's Hospital of Guang'an City, Sichuan, China
| | - Cheng-Xi Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-da A-Mu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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15
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Fatima N, Barra ME, Roberts RJ, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery. Neurosurg Rev 2020; 44:163-175. [PMID: 31938967 DOI: 10.1007/s10143-020-01236-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
Tranexamic acid (TXA) is an effective and commonly used hemostatic agent for perioperative blood loss in various surgical specialties. It is being increasingly used in spinal deformity surgery. We aimed to evaluate the safety and efficacy of topical TXA (tTXA) compared to both placebo and/or intravenous (IV) TXA in patients undergoing spinal deformity surgery. We conducted a systematic review of the electronic databases using different MeSH terms from January 1970 to August 2019. Pooled and subgroup analysis was performed using fixed and random-effect model based upon the heterogeneity (I2). A total of 609 patients (tTXA: n = 258, 42.4%) from 8 studies were included. We found that there was a statistically significant difference in terms of (i) postoperative blood loss [mean difference (MD) - 147.1, 95% CI - 189.5 to - 104.8, p < 0.00001], (ii) postoperative hemoglobin level (MD 1.09, 95% CI 0.45 to 1.72, p = 0.0008), (iii) operative time (MD 7.47, 95% CI 2.94 to 12.00, p < 0.00001), (iv) postoperative transfusion rate [odds ratio (OR) 0.39, 95% CI 0.20 to 0.78, p = 0.007], postoperative drain output (MD, - 184.0, 95% CI - 222.03 to - 146.04, p < 0.00001), and (v) duration of hospital stay (MD - 1.14, 95% CI - 1.44 to - 0.85, p < 0.00001) in patients treated with tTXA compared to the control group. However, there was no significant difference in terms of intraoperative blood loss (p = 0.13) and complications (p = 0.23) between the two comparative groups. Furthermore, low-dose (250-500 mg) tTXA (p < 0.00001) reduced postoperative blood loss more effectively compared to high-dose tTXA (1-3 g) (p = 0.001). Our meta-analysis corroborates the effectiveness and safety of tTXA in spinal deformity surgery.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA.
| | - Megan E Barra
- Department of Clinical Pharmacist, Massachusetts General Hospital, Boston, USA
| | | | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
| | | | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
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16
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Houston BL, Uminski K, Mutter T, Rimmer E, Houston DS, Menard CE, Garland A, Ariano R, Tinmouth A, Abou-Setta AM, Rabbani R, Neilson C, Rochwerg B, Turgeon AF, Falk J, Breau RH, Fergusson DA, Zarychanski R. Efficacy and Safety of Tranexamic Acid in Major Non-Cardiac Surgeries at High Risk for Transfusion: A Systematic Review and Meta-Analysis. Transfus Med Rev 2020; 34:51-62. [DOI: 10.1016/j.tmrv.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/06/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
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17
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Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial. The Journal of Laryngology & Otology 2019; 133:1024-1032. [PMID: 31735180 DOI: 10.1017/s0022215119002305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the effect of tranexamic acid in head and neck surgical procedures. METHODS A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients' group allocation (case or control). RESULTS Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant. CONCLUSION Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.
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18
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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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19
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Mei A, Qiu L. The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2019; 48:1323-1328. [PMID: 30902548 DOI: 10.1016/j.ijom.2018.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/08/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
The efficacy of tranexamic acid in orthognathic surgery remains controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on blood loss for orthognathic surgery. We performed a search of PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through October 2017 for randomized controlled trials (RCTs) assessing the effects of tranexamic acid versus placebo on orthognathic surgery. Meta-analysis was performed using the random-effects model. Six RCTs were included in the meta-analysis. Overall, compared with placebo in orthognathic surgery, tranexamic acid administration results in significantly decreased blood loss [mean difference (MD)=-159.73; 95% confidence interval (CI)=-236.42 to -83.03; P<0.0001], and higher postoperative haemoglobin (MD=0.71; 95% CI=0.11 to 1.31; P=0.02), but has no remarkable impact on postoperative haematocrit (MD=1.23; 95% CI=-1.22 to 3.69; P=0.33) and operation time (MD=-2.35; 95% CI=-18.05 to 13.36; P=0.77). In addition, patients with orthognathic surgery need decreased amounts of irrigant fluid (MD=-229.23; 95% CI=-399.63 to -58.83; P=0.008) after using tranexamic acid. We concluded that tranexamic acid promotes the bleeding control in orthognathic surgery.
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Affiliation(s)
- A Mei
- Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - L Qiu
- Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
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20
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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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21
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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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22
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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 Effect of Tranexamic Acid and Gender on Intraoperative Bleeding in Orthognathic Surgery—A Randomized Controlled Trial. J Oral Maxillofac Surg 2018; 76:1327-1333. [DOI: 10.1016/j.joms.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 01/07/2023]
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Akbas E, Cebi Z, Cansiz E, Isler SC, Cakarer S. Does intravenous tranexamic acid reduce blood loss during surgically assisted rapid palatal expansion? J Istanb Univ Fac Dent 2017; 51:32-37. [PMID: 29114428 PMCID: PMC5624143 DOI: 10.17096/jiufd.94203] [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: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the efficacy of tranexamic acid (TXA) in reducing blood loss during surgically assisted
rapid palatal expansion (SARPE) procedure. Subjects and Methods: A total of 34 patients (12 male, 22 female) who had been treated surgically under general anesthesia with SARPE
including pterygoid disjunction for transverse maxillary deficiency (TMD) were included in this study. The study group (n=17) received intravenous (IV)
TXA 10 mg/kg as a preoperative bolus; the control group (n=17) received normal saline solution. Preoperative and postoperative haemoglobin and haematocrit
values, intraoperative blood loss, and any blood product transfusion were recorded. Results: Blood loss during SARPE was statistically significantly less in the study group than the control group (p=0.0001). Conclusion: Preoperative IV administration of TXA can effectively control blood loss during when SARPE with pterygoid disjunction is performed.
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Affiliation(s)
- Emine Akbas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Zerrin Cebi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Erol Cansiz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Sabri Cemil Isler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Sırmahan Cakarer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
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Apipan B, Rummasak D, Narainthonsaenee T. The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study. Int J Oral Maxillofac Surg 2017; 47:608-612. [PMID: 29126691 DOI: 10.1016/j.ijom.2017.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to compare the effects of three dosage regimens of intravenous tranexamic acid and normal saline placebo on blood loss and the requirement for transfusion during bimaxillary osteotomy. A prospective, randomized, double-blind, placebo-controlled study was performed. Eighty patients scheduled for elective bimaxillary osteotomy were divided into four groups: a placebo group and three groups receiving a single dose of tranexamic acid 10, 15, or 20mg/kg body weight after the induction of anaesthesia. Demographic data, the anaesthetic time, the operative time, and the experience of the surgical team were similar in the four groups. Patients receiving placebo had increased blood loss compared to those receiving tranexamic acid. No significant difference in blood loss was found among those who received 10, 15, or 20mg/kg body weight of tranexamic acid. There was no significant difference in transfusion requirement, amount of 24-h postoperative vacuum drainage, length of hospital stay, or complications among the four groups. Prophylactic tranexamic acid decreased bleeding during bimaxillary osteotomy. Of the three dosages of tranexamic acid studied, the most efficacious and cost-effective dose to reduce bleeding was 10mg/kg body weight.
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Affiliation(s)
- B Apipan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Rajathavi, Bangkok, Thailand.
| | - D Rummasak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Rajathavi, Bangkok, Thailand
| | - T Narainthonsaenee
- Loei Hospital, Tambon Kut Pong, Amphoe Mueang Loei, Changwat Loei, Thailand
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The Efficacy and Safety of Tranexamic Acid in Cranio-Maxillofacial and Plastic Surgery. J Craniofac Surg 2016; 27:374-9. [PMID: 26967076 DOI: 10.1097/scs.0000000000002250] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The antifibrinolytic drug tranexamic acid (TXA) is effective in reducing blood loss and transfusion requirements in other fields of elective surgery and its use is emerging in a number of plastic surgical subspecialties. This systematic review and meta-analysis evaluates the current evidence for the efficacy and safety of TXA in craniomaxillofacial, head and neck, breast, aesthetic, burns, and reconstructive microsurgery. We searched PubMed, EMBASE, Medline, The Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials for randomized controlled trials of TXA in plastic surgery. Studies were analyzed using standard methodology. A total of 7965 records were screened, of which 14 met the inclusion criteria. Seven were suitable for meta-analysis. In craniofacial surgery, TXA was associated with a mean reduction in blood loss of 18.2 mL/kg (P = 0.00001) and a mean reduction in blood transfusion of 8.7 mL/kg (P = 0.0001). In orthognathic surgery, TXA was associated with a mean reduction in blood loss of 156 mL (P = 0.001). Tranexamic acid may also have a role in reducing drainage output volumes in oncological breast excision and lymph node dissection of the neck. Level-1 evidence for efficacy in aesthetic surgery, burns, and reconstructive microsurgery is lacking. Although no reported complications were attributable to TXA, there remain no phase IV trials published. Level-1 evidence supports the use of TXA in craniofacial and orthognathic surgery. There exists an unmet need for studies in areas, including burns, aesthetic surgery, and reconstructive microsurgery. Phase IV trials in areas of proven efficacy are also required.
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The Efficacy of Preoperative Oral Tranexamic Acid on Intraoperative Bleeding During Rhinoplasty. J Craniofac Surg 2016; 27:97-100. [PMID: 26674898 DOI: 10.1097/scs.0000000000002273] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Perioperative bleeding is a common side effect of rhinoplasty which may impose the blood transfusion to the patients. As a result of risks and cost of blood transfusion, this study is planned to reduce blood loss in these surgeries. Since tranexamic acid (TXA) has been reported to reduce bleeding and subsequent possible need for blood transfusion, the purpose of this study was to evaluate the efficacy of oral TXA on blood loss during rhinoplasty. METHODS AND MATERIALS In this double-blind, randomized, placebo-controlled clinical trial, 50 participants underwent rhinoplastic surgery. These participants were divided into 2 groups; 25 were randomly assigned to each 1. The patients in the first group received 1 g (2 × 500 mg) tranexamic acid tablets, and the patients in the second group received placebo 2 hours before starting the surgery. All patients were operated by the same surgical team and the same anesthetic techniques were used during the surgery. Gender, age, BMI, duration of operation, the amount of blood loss, and surgeon's satisfaction rate were the variables studied. RESULTS The first group (TXA group) consisted of 11 males (44%) and 14 females (56%) and the second group consisted of 13 males (52%) and 12 females (48%). There was no statistical difference in the distribution of the variables between the 2 groups, except for the blood loss, duration of operation, and surgeon's satisfaction. The mean total blood loss was 144.6 ± 60.28 mL in "group 1" and 199.6 ± 73.05 mL in "group 2" (P < 0.05). Duration of operation in the first group was less than the second group (2.60 ± 0.53 hours vs. 2.99 ± 0.59 hours) (P = 0.017). The surgeon was more satisfied with the quality of surgical field and visualization in "group 1" (3.76 ± 0.72) than "group 2" (2.16 ± 0.50) (P = 0.001). CONCLUSION The preoperative administration of 1 g oral tranexamic acid significantly decreased the blood loss in patients undergoing rhinoplastic surgery without any significant adverse effects.Iranian registry no:IRCT201312271674N10 (www.irct.ir).
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Christabel A, Anantanarayanan P, Subash P, Soh C, Ramanathan M, Muthusekhar M, Narayanan V. Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: a prospective, multi-centre, triple-blind, randomized controlled trial. Int J Oral Maxillofac Surg 2016; 45:180-5. [DOI: 10.1016/j.ijom.2015.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/10/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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Prevention of Bleeding in Orthognathic Surgery--A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Oral Maxillofac Surg 2015; 74:139-50. [PMID: 26073131 DOI: 10.1016/j.joms.2015.05.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of the present study was to evaluate the efficacy of hemostatic adjuncts on intraoperative blood loss (IOB) in orthognathic surgery (OS) detected by randomized controlled trials (RCTs) of the highest quality. MATERIALS AND METHODS A search of the Medline, Cochrane, Embase, and Web of Science databases was performed in January 2015, and the risk of bias was assessed using the Jadad and Delphi scales. The predictor variable was the hemostatic measures, and the main outcome variable was the total IOB volume. The secondary outcome variables were the hemoglobin and hematocrit and operating time. This review is registered at PROSPERO (CRD42014014840). RESULTS Eleven trials were included for review. The individual trials demonstrated the effects on IOB from hypotensive anesthetic regimens, the use of aprotinin, and the herbal medicine Yunnan Baiyao. Six studies of tranexamic acid (TXA), with 288 patients, were suitable for a meta-analysis of continuous data. TXA reduced IOB by an average of 171 mL (95% confidence interval [CI] -230 to -112; P < .00001). Its topical use yielded similarly significant results (mean difference -197, 95% CI -319 to -76; P < .001). A subgroup analysis showed a decreased operating time in the TXA groups by an average of 15 minutes (mean difference -14.78, 95% CI -22.21 to -7.35; P < .0001). CONCLUSIONS Efficient hemostatic adjuncts exist for OS. Our meta-analysis showed that TXA significantly reduces IOB by an average of one third, regardless of whether it was given intravenously (IV) or applied topically. Additional RCTs are needed to confirm the effect of topical TXA in OS, and larger studies of intravenous administration are needed before any routine recommendations. No hemostatic effect of hypotensive anesthesia was found, mainly owing to imprecise descriptions of the blinding procedures. Transparent and uniform trial reporting is thus encouraged in future studies.
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Al-Sebaei MO. Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients. Patient Saf Surg 2014; 8:41. [PMID: 25309625 PMCID: PMC4193983 DOI: 10.1186/s13037-014-0041-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/15/2014] [Indexed: 12/25/2022] Open
Abstract
Background Patients undergoing orthognathic procedures can require blood transfusions. The objectives of this study were to evaluate the predictors of intra-operative blood loss in patients undergoing orthognathic procedures and the transfusion rates and practices of our institution. Materials and methods This retrospective study included 92 patients who underwent the following four types of orthognathic procedures: Group 1, bimaxillary; Group 2, bimaxillary with bone grafts; Group 3, LeFort I osteotomies; and Group 4, LeFort I osteotomies with bone grafts. The intra-operative blood loss, operative time, age, gender and pre- and post-operative HGB and HCT were assessed. Results The mean blood loss for all groups was 650 ± 397.8 mL, and there were differences in blood loss between the four groups (p = 0.211). The mean operative time was 5 hours and 32 minutes. There were no differences in intra-operative blood loss between the genders or the BMI categories. The operative time was moderately correlated with the intra-operative blood loss (p < 0.001, r =0.332). Eighteen of the 92 patients (19.5%) received blood transfusions. The mean intra-operative blood loss was higher among the patients who received transfusions (p < 0.001). Conclusions The only predictor of intra-operative blood loss was operative time. The observed transfusion rate was higher than those that have been reported for similar procedures; thus, our institution needs to revisit our transfusion policy and use more time-efficient techniques in the operating room.
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Affiliation(s)
- Maisa O Al-Sebaei
- Department of Oral and Maxillofacial Surgery, King AbdulAziz University, Faculty of Dentistry, PO Box 80209, Jeddah, 21589 Kingdom of Saudi Arabia
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Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies – A prospective, triple blinded randomized clinical trial. J Craniomaxillofac Surg 2014; 42:1221-4. [DOI: 10.1016/j.jcms.2014.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/28/2013] [Accepted: 03/10/2014] [Indexed: 11/21/2022] Open
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Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. J Oral Maxillofac Surg 2014; 73:129-33. [PMID: 25443384 DOI: 10.1016/j.joms.2014.07.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE Perioperative hemorrhage is an important concern during orthognathic surgery. The purpose of this study was to assess the effect of tranexamic acid (TXA) irrigation on perioperative hemorrhage during orthognathic surgery. MATERIALS AND METHODS In this double-blind, randomized controlled clinical trial, 56 participants who underwent orthognathic surgery were divided into 2 groups. The patients in the first group received TXA irrigation with normal saline (1 mg/mL), and the patients in the second group had normal saline for irrigation during orthognathic surgery. Age, gender, operation duration, the amount of irrigation solution used, and preoperative hemoglobin, hematocrit, and weight were the variables that were studied. The use of TXA solution for irrigation was the predictive factor of the study. RESULTS Each group consisted of 28 patients. Group 1 consisted of 15 male patients (53.6%) and 13 female patients (46.4%) and group 2 consisted of 14 male patients (50%) and 14 female patients (50%). There was no difference in the distributions of the variables between the 2 groups, except for the duration of the operation. The mean duration of the operation was 3.94 ± 0.61 hours in group 1 and 4.17 ± 0.98 hours in group 2, and the difference in this respect between the 2 groups was statistically significant (P < .05). The mean intraoperative blood loss was 817.85 ± 261.83 mL in group 1 and 575.00 ± 286.90 mL in group 2 (P < .05). The mean volume of irrigation was 1,057.14 ± 407.04 mL in group 1 and 843.57 ± 275.48 mL in group 2 (P > .05). CONCLUSIONS TXA is effective in reducing intraoperative blood loss in patients for whom substantial blood loss is anticipated.
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Tranexamic Acid reducing blood transfusion in children undergoing craniosynostosis surgery. J Craniofac Surg 2014; 24:299-303. [PMID: 23348305 DOI: 10.1097/scs.0b013e3182710232] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Intraoperatively administered tranexamic acid (TXA) can lessen blood loss during orthopedic and cardiovascular surgery, but its efficacy in craniosynostosis surgery is uncertain. Therefore, a meta-analysis performed with published comparative studies was to determine whether TXA could reduce packed red blood cells (or erythrocytes) (PRBCs) transfused and blood loss during pediatric craniosynostosis surgery. METHODS Two PubMed and EMBASE electronic databases were searched until June 2012. Eligible studies were restricted in comparative controlled trials. RESULTS Four studies in 3 articles with 138 patients were included. The results showed that intraoperative administration of TXA can significantly reduce transfusion of PRBCs (weighed mean difference [WMD] = -10.81, 95% confidence interval [CI] = -16.84 to -4.78, P < 0.00001). In the level of blood loss, the meta-analysis on 4 studies showed that the difference was statistically significant (WMD = -20.53, 95% CI = -32.26 to -8.80, P = 0.0006) between the TXA groups and the control groups. However, the subgroup analysis on randomized controlled trials showed that TXA did not significantly reduce blood loss during surgery compared with the placebo group (WMD = -30.79, 95% CIs = -71.72 to 10.14, P = 0.14). CONCLUSIONS Tranexamic acid can significantly reduce the transfusion of PRBCs in children undergoing craniosynostosis surgery. However, there is a controversy on the efficacy of TXA in reducing blood loss. Therefore, new randomized controlled trials to assess the effects of TXA in children with craniosynostosis surgery should be conducted.
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Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q. The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:595-600. [DOI: 10.1016/j.oooo.2012.09.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/03/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
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