1.
The Efficacy of Tranexamic Acid on the Postoperative Bleeding in Patients Receiving Head-and-Neck Surgery: A Meta-Analysis
Kim DH, Kim SW, Basurrah MA, Hwang SH
Ear, nose, & throat journal. 2023;:1455613231155855
Abstract
OBJECTIVES We assessed the effect of tranexamic acid on postoperative bleeding, and any adverse effects, in patients undergoing head-and-neck surgery. METHODS We searched databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their dates of inception to August 31, 2021. We analyzed studies that compared bleeding-related morbidity between perioperative tranexamic acid and placebo (control) groups. We subanalyzed tranexamic acid administration methods. RESULTS The extent of postoperative bleeding (standardized mean difference [SMD] = -0.7817, [-1.4237; -0.1398], P = 0.0170, I(2) = 92.2%) was significantly less in the treatment group. However, there were no significant between-group differences in terms of operative time (SMD = -0.0463 [-0.2147; 0.1221]; P = 0.5897, I(2) = 0.0% [0.0%; 32.9%]); intraoperative blood loss (SMD = -0.7711 [-1.6274; 0.0852], P = 0.0776, I(2) = 94.4%); drain removal timing (SMD = -0.3382 [-0.9547; 0.2782], P = 0.2822, I(2) = 81.7%); or the amount of infused perioperative fluid (SMD = -0.0622 [-0.2615; 0.1372], P = 0.5410, I(2) = 35.5%). Also, there were no significant between-group differences in laboratory findings (serum bilirubin, creatinine, and urea levels; and the coagulation profiles) between the tranexamic acid and control groups. Topical application was associated with a shorter postoperative drain tube dwell time than was systemic administration. CONCLUSION Perioperative tranexamic acid significantly reduced postoperative bleeding in patients undergoing head-and-neck surgery. Also, topical administration might be more effective in postoperative bleeding and postoperative drain tube dwell time.
2.
Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta-analysis and systematic review
Kim DH, Kim S, Kang H, Jin HJ, Hwang SH
The Laryngoscope. 2018
Abstract
OBJECTIVES Tranexamic acid might help control bleeding during surgery because of antifibrinolytic characteristics. We aimed to evaluate the effectiveness of systemic tranexamic acid compared to control in blood loss, operative time, and surgical field and incidence of postoperative emesis and thromboembolism in endoscopic sinus surgery. METHODS Two authors independently searched six databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their inception to July 2018. The included studies compared perioperative tranexamic acid administration (treatment group) with a placebo, and the outcomes of interest were intraoperative morbidities, including surgical time, operative bleeding, and hypotension; postoperative morbidities such as nausea and vomiting; and coagulation profiles. RESULTS Seven studies comprising 562 participants were reviewed in this study. Operative time (standardized mean difference (SMD) = -0.60; 95% confidence interval (CI)[-0.93, -0.29]) and intraoperative blood loss (SMD = -0.66; 95% CI [-0.86, -0.46]) were statistically lower in the treatment group than placebo group; and the quality of the surgical field (SMD = -0.80; 95% CI [-1.12; -0.48]) and surgeon satisfaction (SMD = 1.74; 95% CI [1.36; 2.13]) were statistically higher in the treatment group than the placebo group. By contrast, there were no significant differences in the hemodynamic (SMD = 0.08; 95% CI [-0.20; 0.37]) and coagulation profiles (SMD = -0.18; 95% CI [-0.42, 0.07]) of the two groups. Additionally, tranexamic acid had no significant effect on emetic or thrombotic events compared to placebo. CONCLUSION This meta-analysis showed that the systemic administration of tranexamic acid could decrease operative time and blood loss intraoperatively, increasing the satisfaction of surgeons. It did not provoke intraoperative hemodynamic instability, postoperative emetic events, or coagulation profile abnormality. Only a small number of studies were enrolled, so further trials are needed to confirm the results of this study. LEVEL OF EVIDENCE IA. Laryngoscope, 2018.