Orthognathic Surgery-Induced Fibrinolytic Shutdown Is Amplified by Tranexamic Acid

Associate Professor, Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark; and Department of Clinical Biochemistry, University Hospital of Southern Denmark - Esbjerg, Esbjerg, Denmark. Electronic address: johannes.sidelmann@rsyd.dk. Professor, Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark; and Department of Clinical Biochemistry, University Hospital of Southern Denmark - Esbjerg, Esbjerg, Denmark. Research Fellow, Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark; and Department of Clinical Biochemistry, University Hospital of Southern Denmark - Esbjerg, Esbjerg, Denmark. Head of Department, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark - Esbjerg, Esbjerg, Denmark. Senior Consultant, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark - Esbjerg, Esbjerg, Denmark. Professor, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark - Esbjerg; and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.

J Oral Maxillofac Surg. 2020
Abstract
PURPOSE Little is known of the systemic effects of oral and maxillofacial surgery on the hemostatic balance, including the biochemical effects of tranexamic acid (TXA), on fibrin clot lysis. The present study investigated the effects of orthognathic surgery on fibrin lysis, fibrin structure, and D-dimer and evaluated the effect of TXA on these fibrinolytic measures. MATERIALS AND METHODS The present double-blind, controlled, and randomized, placebo study included patients referred to the Department of Oral and Maxillofacial Surgery at the University Hospital of Southern Denmark-Esbjerg from August 2014 through September 2016. The patients were elective and had a diagnosis of maxillary or mandibular deficiency, either excessive or asymmetric. All patients underwent bimaxillary orthognathic surgery (OS) with or without maxillary segmentation or additional genioplasty. The patients were blindly randomized to treatment with TXA or placebo. The primary predictor variable was OS. The secondary predictor variable was an intravenous dose of 1 g of TXA or equivalent placebo preoperatively. Blood samples were collected before surgery and 5 hours after the initiation of surgery. The primary outcome variable was lysis of fibrin. The fibrin structure properties and D-dimer were secondary outcome measures. The Mann-Whitney U test was used for the within-group comparisons. The Wilcoxon signed rank test was used for the between-group comparisons. RESULTS The sample included 96 patients; 45 had received placebo and 51 had received TXA. Fibrin lysis had decreased after OS (P < .001). The fibrinolytic shutdown had decreased significantly more in the TXA group than in the placebo group (P < .001). OS altered the fibrin structure properties with comparable effects in the 2 groups. D-dimer increased postoperatively but significantly less so in the TXA group than in the control group (P < .001). CONCLUSIONS OS is associated with fibrinolytic shutdown and alters fibrin structure properties, driving the hemostatic balance in a prothrombotic direction. The fibrinolytic shutdown is significantly amplified by TXA.
Study details
Language : eng
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