Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery
Khanwalkar A, Chan E, Roozdar P, Kim D, Ma Y, Hwang PH, Nayak JV, Patel ZM
International forum of allergy & rhinology. 2023
BACKGROUND Postoperative epistaxis is a known possibility following endoscopic sinonasal surgery. Tranexamic acid (TXA) has been shown to reduce intraoperative blood loss and improve the visual field. This study evaluates the clinical efficacy of TXA when given at end of surgery to reduce postoperative bleeding. METHODS This randomized, double-blinded placebo-controlled trial was conducted from April to November 2021. Patients scheduled to undergo endoscopic sinus or nasal surgery were randomized to receive an intravenous dose of 1g TXA or saline intraoperatively prior to extubation. A 10-inch visual analog scale (VAS) was used to query patients regarding postoperative bleeding each day for one week. The medical record was examined to determine the need for additional evaluations or interventions for epistaxis. RESULTS 40 patients completed the study. The mean/SD postoperative bleeding VAS for the TXA group on the day of surgery was not significantly different from the saline group (4.82 [2.18] in vs 5.03 [2.14] in, p = 0.8). There were no significant differences between treatment arms on any postoperative day through day 7 (0.67 [1.84] in vs 0.87 [0.99] in, p = 0.7), nor in the reduction in VAS compared to the respective baseline on the day of surgery. There were no significant differences in terms of additional interventions (e.g. additional evaluation in recovery, ED, or clinic, need for packing, or return to OR). CONCLUSION While TXA has previously demonstrated efficacy to reduce intraoperative bleeding during sinonasal surgery, when postoperative bleeding is already minimal at baseline, TXA does not appear to reduce it significantly further. This article is protected by copyright. All rights reserved.
Complications of revision surgery in case of bleeding after thyroid surgery: A systematic review
Galluzzi F, Garavello W
European annals of otorhinolaryngology, head and neck diseases. 2023
OBJECTIVES The aim of this review is to evaluate complications in patients undergoing surgical control of bleeding after thyroid surgery. Secondly, we have analyzed the rate of the main complications. METHODS The databases PubMed and EMBASE were searched for articles regarding complications after revision thyroid surgery for bleeding. A Systematic review methodology based on Preferred Reporting Items for Systematic Reviews and Meta-analysis was performed. RESULTS Nine studies met the inclusion criteria, six are retrospectives and three retrospectives controlled. The overall rate of bleeding after thyroid surgery was 1.38%. In these patients, the most common complication after revision surgery for bleeding is hypoparathyroidism 24.9% (95% CI: 20.7-29.5) followed by recurrent laryngeal nerve injury 8.1% (95% CI: 6.4-10.1) and wound infection 4.5% (95% CI: 2.5-7.6). Tracheostomy and other lethal complications are rarely described. CONCLUSION Although rare, complications after surgical control of bleeding in patients undergoing thyroid surgery can be serious. Therefore, in order to optimize the surgical outcomes, standardized protocol providing early detection and precise hemostasis procedure, is needed. Specific patient-informed consent for this condition should be created.
Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery
Ahmadi MS, Jahanshahi J, Hashemian F, Salimbahrani AR, Haghi N, Khanlarzadeh E
Iranian journal of otorhinolaryngology. 2023;35(126):49-56
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.
Comparative study of the effect of administering two doses of tranexamic acid in patients undergoing adenotonsillectomy
Shafa A, Besharati S, Shetebi H, Shahhoseini S, Rafiee Zadeh A
International journal of physiology, pathophysiology and pharmacology. 2022;14(4):233-239
BACKGROUND Adenotonsillectomy is a safe and common operation to remove adenoids and tonsils. Here we decided to compare the two dosages of tranexamic acid and their effects on hemodynamic changes and anesthesia-related indexes during surgical interventions. METHODS This is a double-blinded clinical trial performed in 2019-2020 on 64 children who were candidates for adenotonsillectomy. The patients were randomly divided into two groups of 32 based on the table of random numbers. Group A received 5 mg/kg slowly tranexamic acid for 10 minutes and group B received 10 mg/kg tranexamic acid slowly for 10 minutes. The study protocol was approved by the Research committee of Isfahan University of Medical Sciences and the Ethics Committee has confirmed it (Ethics code: IR.MUI.MED.REC.1398.639) (Iranian Registry of Clinical Trials (IRCT) code: IRCT20171030037093N33, https://en.irct.ir/trial/46553). RESULTS The mean volume of intraoperative bleeding in children in group A is significantly higher than in children in group B (P < 0.05). However, no significant difference was observed between the length of stay in recovery and the duration of extubation and the mean dose of propofol in the two groups (P > 0.05). The mean arterial oxygen saturation of children in both groups increased significantly over time (P < 0.05). However, no significant difference was observed between the two groups (P > 0.05). According to the results, the mean HR in both groups decreased significantly over time (P < 0.05). In addition, the mean HR in children in the group B was significantly lower than children in the group A (P < 0.05). CONCLUSION Administration of 10 mg/kg of tranexamic acid during tonsillectomy is associated with lower amounts of bleeding and lower heart rate than 5 mg/kg dosage. These results were in line with most previous studies.
The Effect of Desmopressin Intraoperatively on Hemorrhage During the Rhinoplasty Surgery
Youssefy A, Ghabasiah A, Heidari F, Alvandi S, Bastaninezhad S, Hosseini J, Tajdini A
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India. 2022;74(Suppl 3):4761-4765
This clinical trial discusses the efficacy of premedication with desmopressin in the management of bleeding and clears the surgical field during rhinoplasty surgery. This study is a randomized, double-blinded placebo-control clinical trial. Seventy patients were enrolled in this study and divided into two equal intervention-control groups. Thirty minutes before surgery, the intervention group received 500 ml of normal saline containing 0.1 μg/kg desmopressin and, the control group received 500 ml of normal saline. According to the surgeon's opinion, the local distribution of bleeding was dramatically different in both groups. While DDAVP receivers had grade 1 or 2 bleeding (according to the FROMME-BOEZAART grading score), the control group had grade 3 or 4 bleeding, and this difference was statistically meaningful. It seems that intravenous DDAVP can reduce bleeding and clear the surgical field during rhinoplasty surgery, but further studies are needed to determine the exact role and dose of the DDAVP.
Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta-analysis of randomized placebo-controlled trials
Alrajhi AA, Alghamdi AS, Baali MH, Altowairqi AF, Khan MF, Alharthi AS, Albazee E, Abu-Zaid A
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2022
AIM: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=-37.97 ml, 95% CI [-56.97, -18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=-0.97, 95 CI [-1.21, -0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= -3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=-3.73 min, 95% CI [-14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) CONCLUSION Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.
Evaluation of applying topical tranexamic acid to control septorhinoplasy - induced hemorrhage
Habibi AF, Jalali MM, Ashraf A, Hajian A, Nemati S, Ramezani H, Asli RH
American journal of otolaryngology. 2022;43(5):103514
OBJECTIVES Hemorrhagic events related to surgical field is a common disturbing complication which could worsen the outcomes of operation. This study aimed to evaluate how applying of topical tranexamic acid (TXA) could affect bleeding related to septorhinoplasty operation. MATERIAL AND METHODS This double-blind controlled trial study finally evaluated 198 candidates for septorhinoplasty repair who were randomly allocated to two groups: TXA receivers (5 mg/kg) and control group (received 5 mg/kg of saline 0.9 %). Then cumulative volume of hemorrhage was calculated by adding total volume of suctioned blood and numbers of fully blood-filled surgical gauzes (15 mL in each). Additionally postoperative 24 h volume of hemorrhage was measured by counting number of bloody surgical gauzes. RESULTS Of all participants, 90 % were female. The mean age was 26 ± 7 years. Total cumulative volume of hemorrhage during surgery was significantly diminished when topical TXA was applied (p < 0.0001). Additionally drier field of operation was illustrated postoperatively in patients received topical TXA (2 % & 28 % in TXA and saline 0.9 % receivers, respectively) (p < 0.001). CONCLUSION Using topical TXA could decrease bleeding volume and make surgical field of septorhinoplasty drier either during surgery or postoperatively.
Treatment of oroantral communication with Platelet-Rich Fibrin: A systematic review
Salgado-Peralvo AO, Mateos-Moreno MV, Uribarri A, Kewalramani N, Peña-Cardelles JF, Velasco-Ortega E
Journal of stomatology, oral and maxillofacial surgery. 2022
BACKGROUND Oroantral communication (OAC) is the opening between the maxillary sinus and the oral cavity, which constitutes a gate for the mucosal infection in the maxillary sinus. On the other hand, an OAF develops when the OAC does not close spontaneously, remains manifest and is epithelialized. Several methods have been proposed to solve these situations, however, they are associated with increased postoperative morbidity and/or higher associated costs and require some experience of the surgeon to perform them. To overcome these disadvantages, the use of Platelet-Rich Fibrin (PRF) is proposed. The present study aims to perform a systematic review of the literature, collecting cases in which PRF was used in the treatment of OACs/OAFs. MATERIALS AND METHODS An electronic search of the MEDLINE database (via PubMed) and Web of Science was performed using the following MeSH terms (Medical Subjects Headings): (oroantral communication OR oroantral fistula OR buccosinusal communication) AND (platelet-rich fibrin OR prf OR fibrin mesh). The criteria used were those described by the PRISMA® Statement. The search was not time-restricted and was updated to April 2021. RESULTS After searching, 11 articles were included that met the established criteria. In these, PRF was used alone or in combination with bi- or trilaminar techniques achieving complete resolution in 100% of cases (n=116). CONCLUSIONS With the limitations of this study, it can be established that PRF can be used alone for the treatment of OACs/OAFs up to 5 mm and, in larger defects, it is advisable to combine it with bi- or trilaminar techniques. PRF is an effective therapeutic option, with minimal associated postoperative morbidity compared to other techniques and allows the position of the mucogingival junction to be preserved. Its combination with bone grafting improves the starting point before the replacement of the missing tooth with a dental implant.
Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta-analysis
Li B, Wang M, Wang Y, Zhou L
Laryngoscope investigative otolaryngology. 2022;7(4):1206-1216
OBJECTIVE This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle-Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs. RESULTS A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47-0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30-0.64) and 0.70 (95% CI, 0.54-0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13-2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16-0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32-0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34-0.64). CONCLUSIONS Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure. LEVEL OF EVIDENCE 5.
Comparison of Tranexamic acid, Remifentanil, and Hydralazine on the bleeding volume during Dacryocystorhinostomy surgery
Moradi Farsani D, Shetabi H, Rafiee Zadeh A, Saffari Rad N
International journal of physiology, pathophysiology and pharmacology. 2022;14(3):177-186
BACKGROUND Bleeding in Dacryocystorhinostomy (DRC) limits the surgeon's sight and access. Tranexamic acid, Remifentanil, and Hydralazine reduce intraoperative blood loss. However, no study has been carried out to compare the efficacy of the latter drugs during DCR surgery. METHODS Ninety healthy candidates for DCR surgery with chronic Dacryocystitis (aging 20-80) were randomly assigned in groups of 30 to receive low doses of Tranexamic acid (TXA) (10 mg/kg with a maximum dose of 1000 mg), Remifentanil (0.1 µ/kg), or Hydralazine (0.1 mg/kg). All drugs were infused over 15 minutes before the initiation of surgery. The primary outcome was the bleeding volume during the surgery and until 2 hours in recovery. This study was approved by the Iranian Registry of Clinical Trials with the code of IRCT20210614051574N10 (https://en.irct.ir/trial/62759). RESULTS Thirty patients (mean age ± SD: 50.48±13.4) were investigated. Mean blood loss volume was lower in Remifentanil and Hydralazine groups compared with the TXA group (P<0.05); there was no significant difference (P>0.05) in bleeding volume between Remifentanil and Hydralazine groups (Tranexamic acid group: 146.83±91 ml, Remifentanil group: 77.6±52.1 ml, Hydralazine group: 80.0±48.7 ml, 95% confidence interval, P<0.05). CONCLUSION Our results show that Remifentanil and Hydralazine are more effective than Tranexamic acid in bleeding control.