Effect Of Intravenous Vs Topical Tranexamic Acid On Bleeding During Endoscopic Sinus Surgery
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Abstract
Tranexamic acid functions as a hemostatic agent by impeding the degradation of fibrin, potentially offering advantages in the management of surgical bleeding. A search yielded 47 randomised controlled studies. We excluded 24 studies that did not meet our criteria. Our systematic review manuscript included 23 eligible studies. The retrieved, excluded, and included studies were all randomised controlled. 16 of 23 randomised controlled trials, most of which were double-blind controlled versus placebo trials, examined tranexamic acid administration (topical or intravenous). The combined and intravenous administration of tranexamic acid showed a difference. With moderate certainty, tranexamic acid is likely to significantly reduce surgical field bleeding score compared to placebo in 16 studies. Tranexamic acid administered intravenously, topically, locally, or in a dual-administration formulation may improve intraoperative bleeding and the operative field in nasal surgery patients. Additional studies are needed to confirm the results of this study
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References
Vlaminck S, Acke F, Scadding GK, Lambrecht BN, Gevaert P. Pathophysiological and Clinical Aspects of Chronic Rhinosinusitis: Current Concepts. Front Allergy. 2021 Oct 27;2:741788.
Sheth KR, Bernthal NM, Ho HS, Bergese SD, Apfel CC, Stoicea N, Jahr JS. Perioperative bleeding and non-steroidal anti-inflammatory drugs: An evidence-based literature review, and current clinical appraisal. Medicine (Baltimore). 2020 Jul 31;99(31):e20042.
Zhou J. A review of the application of autologous blood transfusion. Braz J Med Biol Res. 2016 Aug 1;49(9):e5493.
Kang H, Hwang SH. Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia? Braz J Otorhinolaryngol. 2020 Jan-Feb;86(1):111-118
Taieb S, Atienza P, Zeitoun JD, Taouk M, Bourguignon J, Thomas C, Rabahi N, Dahlouk S, Lesage AC, Lobo D, Etienney I. Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study. Ann Coloproctol. 2022 Oct;38(5):370-375.
Thongrong C, Kasemsiri P, Carrau RL, Bergese SD. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg. 2013 Jun 13;2013:191543.
Irfan NI, Mohd Zubir AZ, Suwandi A, Haris MS, Jaswir I, Lestari W. Gelatin-based hemostatic agents for medical and dental application at a glance: A narrative literature review. Saudi Dent J. 2022 Dec;34(8):699-707.
Kang H, Hwang SH. Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia? Braz J Otorhinolaryngol. 2020 Jan-Feb;86(1):111-118.
Gupta K, Rastogi B, Krishan A, Gupta A, Singh VP, Agarwal S. The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study. Anesth Essays Res. 2012 Jan-Jun;6(1):70-3.
Taeuber I, Weibel S, Herrmann E, et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Surg. 2021;156(6):e210884.
Kesselheim AS. An empirical review of major legislation affecting drug development: past experiences, effects, and unintended consequences. Milbank Q. 2011 Sep;89(3):450-502.
Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic acid-associated seizures: Causes and treatment. Ann Neurol. 2016 Jan;79(1):18-26.
Baradaranfar MH, Dadgarnia MH, Mahmoudi H, Behniafard N, Atighechi S, Zand V, Baradaranfar A, Vaziribozorg S. The effect of topical tranexamic acid on bleeding reduction during functional endoscopic sinus surgery. Iranian journal of otorhinolaryngology. 2017 Mar;29(91):69.
El‐Ozairy HS, Mady OM, Tawfik GM, Elhennawy AM, Teaima AA, Ebied A, Huy NT. Outcomes of combined use of topical and intravenous tranexamic acid on surgical field quality during functional endoscopic sinus surgery: randomized controlled trial. Head & Neck. 2021 May;43(5):1389-97.
Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. Journal of clinical anesthesia. 2011 Dec 1;23(8):611-5.
Kang H, Hwang SH. Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia? Brazilian Journal of Otorhinolaryngology. 2020 Mar 30; 86:111-8.
Langille MA, Chiarella A, Côté DW, Mulholland G, Sowerby LJ, Dziegielewski PT, Wright ED. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double‐blind randomized controlled trial. In International forum of allergy & rhinology 2013 Apr (Vol. 3, No. 4, pp. 315-318).
Jahanshahi J, Hashemian F, Pazira S, Bakhshaei MH, Farahani F, Abasi R, Poorolajal J. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PloS one. 2014 Aug 18;9(8):e104477.
Nuhi S, Tabrizi AG, Zarkhah L, Ashrafi BR. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iranian journal of otorhinolaryngology. 2015 Sep;27(82):349.
Pannersel vam TA, Rajesh Kumar KV, Karthekeyan RB. Comparative Study of Two Different Intravenous Doses of Tranexamic Acid with Placebo on Surgical Field Quality in Functional Endoscopic Sinus Surgery-A Randomised Clinical Trial. Journal of Clinical & Diagnostic Research. 2019 Dec 1;13(12).
Abdelaziz T, Elsayed H, Salem M, Mahmoud NY. ” The efficacy of oral versus intravenous tranexamic acid in functional endoscopic sinus surgery”. A prospective, randomized, controlled trial. Egyptian Journal of Anaesthesia. 2024 Dec 31;40(1):105-11.
Ratnayake Kumar A, Wood AJ. The safety of topical and intravenous tranexamic acid in endoscopic sinus surgery. Sinusitis. 2022 Oct 18;6(2):56-65.
Sahar M, Hasanein R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egyptian Journal of Anaesthesia. 2015 Jan 1;31(1):1-7.
Achour I, Ben Rhaiem Z, Thabet W, Jdidi J, Mnejja M, Hammami B, Chakroun A, Charfeddine I. The effect of topical tranexamic acid in endoscopic sinus surgery: a triple blind randomized clinical trial. Annals of Otology, Rhinology & Laryngology. 2023 Mar;132(3):244-9.
Beikaei ME, Ghazipour A, Derakhshande VI, Saki N, Nikakhlagh SO. Evaluating the effect of intravenous tranexamic acid on intraoperative bleeding during elective rhinoplasty surgery. Biomed Pharmacol J. 2015 Oct 1;8(October Spl Edition):723-59.
Yang W, Gou H, Li H, Liu Y, Wan Y, Wang C, Wang G, Zhang L. Intravenous tranexamic acid improves the intraoperative visualization of endoscopic sinus surgery for high-grade chronic rhinosinusitis: a randomized, controlled, double-blinded prospective trial. Frontiers in Surgery. 2021 Nov 16;8:771159.
Padhy PK, Narayanaswamy R. Impact of intravenous tranexamic acid on intraoperative bleeding during endoscopic sinus surgery. Bengal Journal of Otolaryngology and Head Neck Surgery. 2019 Dec 29;27(3):198-203.
Khanwalkar A, Chan E, Roozdar P, Kim D, Ma Y, Hwang PH, Nayak JV, Patel ZM. Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery. InInternational Forum of Allergy & Rhinology 2023 Sep (Vol. 13, No. 9, pp. 1584-1591).
Husain S, Ramos JA, Karaf JH, Zahedi FD, Ahmad N, Abdullah B. Efficacy of topical tranexamic acid to reduce bleeding in endoscopic sinus surgery for chronic rhinosinusitis with polyposis. European Archives of Oto-Rhino-Laryngology. 2023 Feb;280(2):737-41.
Kumar, Agrani Ratnayake, and Andrew James Wood. "A double-blind pilot randomized controlled trial of topical tranexamic acid after sinus surgery." (2022).
Zaman SU, Zakir I, Faraz Q, Akhtar S, Nawaz A, Adeel M. Effect of single-dose intravenous tranexamic acid on postoperative nasal bleed in septoplasty. European annals of otorhinolaryngology, head and neck diseases. 2019 Nov 1;136(6):435-8.
Ahmadi MS, Jahanshahi J, Hashemian F, Salimbahrani AR, Haghi N, Khanlarzadeh E. Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery. Iranian Journal of Otorhinolaryngology. 2023 Jan;35(126):49.
Eftekharian HR, Rajabzadeh Z. The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty. Journal of Craniofacial Surgery. 2016 Jan 1;27(1):97-100.
Modir H, Moshiri E, Naseri N, Faraji F, Almasi-Hashiani A. A randomized parallel design trial of the efficacy and safety of tranexamic acid, dexmedetomidine and nitroglycerin in controlling intraoperative bleeding and improving surgical field quality during septorhinoplasty under general anesthesia. Medical Gas Research. 2021 Oct 1;11(4):131-7.
Eftekharian H, Vahedi R, Karagah T, Tabrizi R. Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. Journal of Oral and Maxillofacial Surgery. 2015 Jan 1;73(1):129-33.
Dongare DH, Saundattikar GY. Comparison of intraoperative bleeding and surgical fields with and without tranexamic acid in functional endoscopic sinus surgery. Indian Journal of Clinical Anaesthesia 2018;5(2):233-6.
Eldaba AA, Amr YM, Albirmawy OA. Effects of tranexamic acid during endoscopic sinsus surgery in children. Saudi Journal of Anaesthesia 2013;7:229-33.
El Shal SM, Hasanein R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egyptian Journal of Anaesthesia 2015;31(1):1-7.
Quiroga JM, Jarin PS. Endoscopic sinus surgery perioperative outcome after intravenous tranexamic acid: a double blind randomized controlled trial. Philippine Journal of Otolaryngology-Head and Neck Surgery 2018;33(1):6-11.
Chhapola S, Matta I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. Clinical Rhinology 2011;4:79-81.
Beule AG, Athanasiadis T, Field J, Hosemann W, Wormald PJ, Tan LW. Effects of simulated bleeding in an in vitro nasal fibroblast wound healing model. American Journal of Rhinology & Allergy 2010;24(3):186-91.