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Tranexamic acid in head and neck procedures: a systematic review and meta-analysis of randomized controlled trials
Hemail M Alsubaie1, Ahmed Abu-Zaid2,3, Suhail I Sayed4
1Department of Otolaryngology - Head and Neck Surgery, King Abdullah Medical City, Mecca, Saudi Arabia. haamm1478@hotmail.com.
Objective:
We conducted a meta-analysis of all randomized controlled trials (RCTs) that examined the benefits of tranexamic acid (TXA) among cancer patients undergoing head and neck (H&N) procedures.
Methods:
We screened five databases from inception until 20 June 2021 and evaluated the risk of bias of the eligible studies. We pooled continuous outcomes using the weighted mean difference (WMD) with 95% confidence interval (CI).
Results:
Five studies, comprising seven RCTs, met the inclusion criteria. This meta-analysis included a total of 540 patients; 265 and 275 patients were assigned to the TXA and control group, respectively. Overall, the included RCTs revealed a low risk of bias. The volume of postoperative bleeding was significantly lower in favor of the TXA group compared with the control group (n = 7 RCTs, WMD = - 51.33 ml, 95% CI [- 101.47 to - 1.2], p = 0.04). However, no significant difference was found between both groups regarding the volume of intraoperative bleeding (n = 6 RCTs, WMD = - 3.48 ml, 95% CI [- 17.11 to 10.15], p = 0.62), postoperative hemoglobin (n = 3 RCTs, WMD = 0.42 mg/dl, 95% CI [- 0.27 to 1.11], p = 0.23), duration of drainage tube removal (n = 4 RCTs, MD = - 0.41 days, 95% CI [- 1.14 to 0.32], p = 0.27), and operation time (n = 6 RCTs, WMD = 1.59 min, 95% CI [- 10.09 to 13.27], p = 0.79). TXA was safe and did not culminate in thromboembolic events or major coagulation derangements.
Conclusion:
TXA administration is safe and significantly reduces the volume of postoperative bleeding. However, no difference is identified between TXA and control groups regarding the volume of intraoperative bleeding, postoperative hemoglobin level, duration of drainage tube removal, and operation time.
Insights
Tranexamic acid (TXA) significantly reduces postoperative bleeding in head and neck cancer surgery patients. This meta-analysis found TXA safe, with no increased risk of complications.
Area of Science:
- Oncology
- Surgical Innovation
- Pharmacology
Background:
- Head and neck (H&N) cancer surgeries often involve significant bleeding.
- Tranexamic acid (TXA) is an antifibrinolytic agent that may reduce blood loss.
- Evidence on TXA's efficacy in H&N cancer patients is fragmented.
Purpose of the Study:
- To perform a meta-analysis of randomized controlled trials (RCTs) evaluating TXA's benefits in H&N cancer procedures.
- To assess TXA's impact on postoperative bleeding and other surgical outcomes.
- To determine the safety profile of TXA in this patient population.
Main Methods:
- Systematic screening of five databases for relevant RCTs up to June 2021.
- Inclusion of seven RCTs involving 540 patients (265 TXA, 275 control).
- Meta-analysis of continuous outcomes using weighted mean difference (WMD) and 95% confidence intervals (CI), with risk of bias assessment.
Main Results:
- TXA significantly reduced postoperative bleeding volume (WMD = -51.33 ml, p=0.04).
- No significant differences were observed in intraoperative bleeding, postoperative hemoglobin, drainage duration, or operation time.
- TXA administration was found to be safe, with no reported thromboembolic events or major coagulation issues.
Conclusions:
- TXA is a safe and effective agent for reducing postoperative bleeding in patients undergoing H&N cancer surgery.
- TXA does not appear to influence intraoperative bleeding, hemoglobin levels, or surgical duration.
- Further research may explore optimal TXA protocols in specific H&N cancer surgical contexts.
