Tranexamic Acid in rhinoplasty and septoplasty: a systematic review and meta-analysis of randomized controlled trials
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Published version
Author(s)
Type
Journal Article
Abstract
Background: Perioperative bleeding poses significant challenges to rhinoplasty/septoplasty procedures; tranexamic acid (TXA), an antifibrinolytic, may help reduce this bleeding, though its effectiveness in these specific surgeries is not well-established. This systematic review and meta-analysis aims to evaluate the impact of TXA on perioperative bleeding in rhinoplasty and septoplasty.
Methods: The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized comparative studies focusing on adult patients undergoing rhinoplasty or septoplasty. The primary outcomes assessed were intraoperative blood loss, surgery duration, and surgeon satisfaction. A Random Effects model was employed. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane’s RoB tool for randomized studies and the ROBINS-I tool for non-randomized studies.
Results: The search yielded 154 results; 11 RCTs, with 968 patients, were included. The meta-analysis showed significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24, P=0.002) and superior surgeon satisfaction in favor of TXA utilization (SMD -2.73; 95% CI: -5.33 to -0.12; P = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, was also in favour of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; P = 0.02) and oral TXA (; No statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; P = 0.23). All studies were found to be of high quality, with low risk of bias.
Conclusion: The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.
Methods: The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized comparative studies focusing on adult patients undergoing rhinoplasty or septoplasty. The primary outcomes assessed were intraoperative blood loss, surgery duration, and surgeon satisfaction. A Random Effects model was employed. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane’s RoB tool for randomized studies and the ROBINS-I tool for non-randomized studies.
Results: The search yielded 154 results; 11 RCTs, with 968 patients, were included. The meta-analysis showed significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24, P=0.002) and superior surgeon satisfaction in favor of TXA utilization (SMD -2.73; 95% CI: -5.33 to -0.12; P = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, was also in favour of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; P = 0.02) and oral TXA (; No statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; P = 0.23). All studies were found to be of high quality, with low risk of bias.
Conclusion: The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.
Date Issued
2024-11-05
Date Acceptance
2024-09-05
Citation
Plastic and Reconstructive Surgery, Global Open, 2024, 12 (11)
ISSN
2169-7574
Publisher
Wolters Kluwer
Journal / Book Title
Plastic and Reconstructive Surgery, Global Open
Volume
12
Issue
11
Copyright Statement
© 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Publication Status
Published
Article Number
ARTN e6275