The Effect of Tranexamic Acid in Lowering Bleeding, Edema, and Ecchymosis in Primary Rhinoplasty: A Systematic Review & Meta-Analysis
Connor McGuire1, Sean Nurmsoo1, Osama A. Samargandi2, Michael Bezuhly2.
1Dalhousie Medical School, Halifax, NS, Canada, 2Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada.
Purpose: To systematically examine the role of TXA in reducing bleeding, edema, and ecchymosis among patients undergoing primary elective rhinoplasty.
Methods: A systematic review was undertaken using a computerized of MEDLINE, EMBASE, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The population of interest in this study consisted of adult patients undergoing primary elective rhinoplasty. The intervention considered was the use of TXA. The control group was comprised of patients receiving a placebo. The primary outcomes of interest were intraoperative bleeding and post-operative edema and ecchymosis. In vitro or animal studies were excluded and only English language articles were included. PRISMA guidelines were followed and articles were assessed using the Cochrane Collaboration risk of bias tool and the GRADE criteria. Random effects meta-analysis was performed to determine overall effect size. The primary outcomes were intraoperative blood loss and post-operative edema and ecchymosis.
Results: Five studies were included. All studies were randomized controlled trials published within the past five years. Mean patient age was 27 (range 16 to 42) while the mean sample size was 66 (range 50 to 96). Meta-analysis of four studies indicated that TXA treatment resulted in an average reduction in blood loss of 41.6 mL (95% confidence interval 13.4 mL to 69.8 mL) when compared to controls (p=0.004). Three studies indicated that edema and ecchymosis were reduced with TXA treatment compared to controls; however, there was no significant difference when compared to steroids. Four studies (80 percent) were considered of high methodological quality with a low risk of bias. The overall quality of evidence was high.
Conclusions: TXA has the ability to significantly reduce intraoperative blood loss, edema, and ecchymosis among patients undergoing primary elective rhinoplasty.
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