To compare the effectiveness of tranexamic acid (TXA) in reducing blood loss and decreasing surgery duration in craniomaxillofacial surgery.
Methods:
The literature was searched systematically for all comparative studies of the effect of TXA on craniomaxillofacial surgery with placebo to evaluate the efficacy of TXA in craniomaxillofacial surgery. The primary outcome was intraoperative blood loss, and secondary outcomes were postoperative hematocrit, postoperative hemoglobin, and operation duration.
Results:
This systematic review included 16 studies consisting of 958 patients. Meta-analysis revealed that compared with the placebo group, the TXA group showed a significant reduction in intraoperative blood loss of 139.81 mL (95% confidence interval, CI: −179.66 to −99.96 mL; p < 0.01), a shortening of the maxillary surgery duration of 15.48 min (95% CI: −21.03 to −9.92 min; p < 0.01), an elevation of the postoperative hemoglobin level of 0.74 mg/dL (95% CI: 0.42 to 1.07 mg/dL; p < 0.01), and a limited effect on increasing the postoperative hematocrit level of 1.77% (95% CI: 0.17 to 3.36; p = 0.03).
Conclusion:
The use of TXA in craniomaxillofacial surgery can effectively reduce intraoperative blood loss, maintain elevate postoperative hemoglobin and hematocrit levels, and reduce the operation duration.
Get full access to this article
View all access options for this article.
References
1.
ApipanB. The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study. Int J Oral Maxillofac Surg. 2018; 47(11):1504–1505.
2.
DadureC, SauterM, BringuierS, et al.Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery. Anesthesiology. 2011; 114(4):856–861.
3.
HsuG, TaylorJA, FiadjoeJE, et al.Aminocaproic acid administration is associated with reduced perioperative blood loss and transfusion in pediatric craniofacial surgery. Acta Anaesthesiol Scand. 2016; 60(2):158–165.
4.
DakirA, RamalingamB, EbenezerV, DhanaveluP. Efficacy of tranexamic acid in reducing blood loss during maxillofacial trauma surgery-a pilot study. J Clin Diagn Res. 2014; 8(5):Zc06–Zc08.
5.
CaiJ, RibkoffJ, OlsonS, et al.The many roles of tranexamic acid: an overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020; 104(2):79–87.
6.
ZirkM, ZinserM, BullerJ, et al.Supportive topical tranexamic acid application for hemostasis in oral bleeding events—retrospective cohort study of 542 patients. J Craniomaxillofac Surg. 2018; 46(6):932–936.
7.
AlaifanT, AlenazyA, Xiang WangD, et al.Tranexamic acid in cardiac surgery: a systematic review and meta-analysis (protocol). BMJ Open. 2019; 9(9):e028585.
8.
JenningsJD, SolarzMK, HaydelC. Application of tranexamic acid in trauma and orthopedic surgery. Orthop Clin North Am. 2016; 47(1):137–143.
9.
YerneniK, BurkeJF, TuchmanA, et al.Topical tranexamic acid in spinal surgery: a systematic review and meta-analysis. J Clin Neurosci. 2019; 61:114–119.
10.
SchroederRJ, 2nd, LangsdonPR. Effect of local tranexamic acid on hemostasis in rhytidectomy. Facial Plast Surg Aesthet Med. 2020; 22(3):195–199.
11.
McGuireC, NurmsooS, SamargandiOA, BezuhlyM. Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: a systematic review and meta-analysis. JAMA Facial Plast Surg. 2019; 21(3):191–198.
12.
ChenH, ChenM. The efficacy of tranexamic acid for brain injury: a meta-analysis of randomized controlled trials. Am J Emerg Med. 2020; 38(2):364–370.
13.
KaewpradubP, ApipanB, RummasakD. Does tranexamic acid in an irrigating fluid reduce intraoperative blood loss in orthognathic surgery? A double-blind, randomized clinical trial. J Oral Maxillofac Surg. 2011; 69(6):e186–e189.
14.
LiberatiA, AltmanDG, TetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151(4):W65–W94.
15.
HigginsJP, AltmanDG, GotzschePC, et al.The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928.
16.
HowickJ, ChalmersI, GlasziouP, et al. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. www.cebm.net/index.aspx?o=5653. Accessed September26, 2020.
17.
GoobieSM, StaffaSJ, MearaJG, et al.High-dose versus low-dose tranexamic acid for paediatric craniosynostosis surgery: a double-blind randomised controlled non-inferiority trial. Br J Anaesth. 2020; 125(3):336–345.
18.
ChoiWS. The value of tranexamic acid in orthognathic surgery. Int J Oral Maxillofac Surg. 2015; 44:e3.
19.
ChristabelA, AnantanarayananP, SubashP, et al.Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: a prospective, multi-centre, triple-blind, randomized controlled trial. Int J Oral Maxillofac Surg. 2016; 45(2):180–185.
20.
EftekharianH, VahediR, KaragahT, TabriziR. Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. J Oral Maxillofac Surg. 2015; 73(1):129–133.
21.
EscherPJ, TuAD, KearneySL, et al.A protocol of situation-dependent transfusion, erythropoietin and tranexamic acid reduces transfusion in fronto-orbital advancement for metopic and coronal craniosynostosis. Childs Nerv Syst. 2021; 37(1):269–276.
22.
GoobieSM, MeierPM, PereiraLM, et al.Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology. 2011; 114(4):862–871.
23.
KarimiA, MohammadiSS, HasheminasabM. Efficacy of tranexamic acid on blood loss during bimaxilary osteotomy: a randomized double blind clinical trial. Saudi. J. Anaesth. 2012; 6(1):41–45.
24.
SankarD, KrishnanR, VeerabahuM, VikramanB. Evaluation of the efficacy of tranexamic acid on blood loss in orthognathic surgery. A prospective, randomized clinical study. Int J Oral Maxillofac Surg., 2012; 41(6):713–717.
25.
SecherJJ, SidelmannJJ, IngerslevJ, ThornJJ, PinholtEM. The effect of tranexamic acid and gender on intraoperative bleeding in orthognathic surgery—a randomized controlled trial. J Oral Maxillofac Surg. 2018; 76(6):1327–1333.
26.
ChristabelA, MuthusekharMR, NarayananV, et al.Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies—a prospective, triple blinded randomized clinical trial. J Craniomaxillofac Surg. 2014; 42(7):1221–1224.
27.
ChoiWS, IrwinMG, SammanN. The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg. 2009; 67(1):125–133.
28.
ZiaeiS, JoniS, ShahriarR, ShahzamaniM. Does intravenous tranexamic acid reduce bleeding during mastoidectomy? Am. J. Blood Res. 2020; 10(3):46–51.
29.
BalshemH, HelfandM, SchunemannHJ, et al.GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol., 2011; 64(4):401–406.
30.
MeiA, QiuL. The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2019; 48(10):1323–1328.
31.
OlsenJJ, SkovJ, IngerslevJ, ThornJJ, PinholtEM. Prevention of bleeding in orthognathic surgery—a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofacl Surg. 2016; 74(1):139–150.
32.
SiotouK, SiotosC, AziziA, et al.The role of antifibrinolytics in reducing blood loss during craniofacial or orthognathic surgical procedures: a meta-analysis. J Oral Maxillofac Surg. 2019; 77(6):1245–1260.
33.
SongG, YangP, HuJ, ZhuS, LiY, WangQ. The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115(5):595–600.
34.
ZhaoH, LiuS, WuZ, ZhaoH, MaC. Comprehensive assessment of tranexamic acid during orthognathic surgery: a systematic review and meta-analysis of randomized, controlled trials. J Craniomaxillofac Surg. 2019; 47(4):592–601.
35.
ZhangLK, MaJX, KuangMJ, et al.Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: a systematic review and meta-analysis. Int J Surg. 2017; 45:77–84.
36.
MurkinJM, FalterF, GrantonJ, YoungB, BurtC, ChuM. High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg. 2010; 110(2):350–353.
37.
AkbasE, CebiZ, CansizE, IslerSC, CakarerS. Does intravenous tranexamic acid reduce blood loss during surgically assisted rapid palatal expansion?. J Istanb Univ Fac Dent. 2017; 51(3):32–37.
38.
EngelM, BodemJP, BuschCJ, et al.The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis. J Craniomaxillofac Surg. 2015; 43(7):1239–1243.
39.
CrantfordJC, WoodBC, ClaiborneJR, et al.Evaluating the safety and efficacy of tranexamic acid administration in pediatric cranial vault reconstruction. J Craniofac Surg. 2015; 26(1):104–107.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
