Table 5.
Randomized Controlled Trials on Local use of Tranexamic Acid in Orthognathic and Endoscopic Sinus Surgery
| Reference, Year, and Publication Type | TXA Group (total sample size), n | Procedure | TXA Concentration, Volume, Mode of Administration | Comparator | Bleeding * | Postoperative Hemorrhagic Incidence/Intervention/Transfusion * |
|---|---|---|---|---|---|---|
| Jabalameli 2006, brief report74 | 26 (56) | Endoscopic sinus surgery | 50 mg/ml, 20 ml of bolus instillation | 20 ml saline as placebo | Intraoperative bleeding (ml) TXA = 174 ± 11 vs placebo 229 ± 24, p < 0.05 | Surgical visual field score according to Boezaart (0–5): TXA = 2.31 ± 0.20 vs placebo 2.53 ± 0.15, p < 0.05 |
| Athanasiadis 2007, article71 | 20 (40) | Bilateral endoscopic sinus surgery | Paired case/control. Investigation of two different concentrations. 100 mg/ml, 10 ml (n = 10) and 10 mg/ml, 10 ml (n = 10) topical irrigation after resection | 10 ml saline as placebo | Operating site assessed as bleeding the least by surgeon (n): TXA = 16 vs placebo = 4, p = 0.007 | None in either group |
| Kaewpradub 2011, article76 | 20 (40) | Orthognathic surgery | 0.5 mg/ml in irrigation fluid | Standard irrigation solution | Intraoperative bleeding (ml) TXA = 833 ± 316 vs comparator 918 ± 424, p = 0.47 | Transfusion need (units of transfused blood): TXA = 0.15 ± 0.36 vs comparator = 0.25 ± 0.55, p = 0.50 |
| Jahanshahi 2014, article75 | 30 (60) | Endoscopic sinus surgery | 50 mg/ml in combination with adrenaline 5 mg/ml, soaked pledgets applied for 10 minutes before surgery | 5 mg/ml adrenaline solution as comparator | Blood loss from initiation until 45 minutes (ml) TXA = 100 ± 53 vs placebo 170 ± 46, p = 0.001 | Surgical visual field score according to Boezaart (0–5): grading significantly lower in TXA group up to 30 minutes (p = 0.003) but not at 45 minutes (p = 0.163) |
| Shehata 2014, article77 | 25 (50) | Endoscopic sinus surgery | 50 mg/ml, 20 ml, for packing and irrigation during surgery | 20 ml saline as placebo | Intraoperative blood loss (ml) TXA = 214 ± 77 vs placebo = 273 ± 178, p < 0.01 | Surgical visual field score according to Boezaart (0–5): TXA = 1.92 ± 0.64 vs placebo 2.64 ± 0.7, p < 0.01 |
| Eftekharian 2015, article73 | 28 (56) | Orthognatic surgery | 1 mg/ml in irrigation fluid | Standard irrigation fluid | Intraoperative blood loss (ml) TXA = 575 ± 287 vs comparator 818 ± 262, p < 0.05 | No transfusion needs in either group. Postoperative bleeding not measured |
| Barandaran-far 2017, article72 | 30 (60) | Endoscopic sinus surgery | 5 mg/ml in first 400 ml of irrigation fluid | Standard irrigation fluid | Intraoperative blood loss (ml) TXA = 236 vs comparator = 234 (SD not given), p = 0.31 | Surgical visual field according to Boezaart (0–5): TXA = 2.73 vs comparator 3.0 (SD not given) p = 0.305 |
TXA, tranexamic acid; SD, standard deviation.
*
Values are mean ± SD unless otherwise stated.