Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery

Area of Science:

• Otolaryngology
• Surgical Innovation
• Pharmacology

Background:

• Chronic rhinosinusitis significantly impacts quality of life, often requiring surgical intervention when conservative treatments fail.
• Functional endoscopic sinus surgery (FESS) demands clear surgical field visibility for safety and efficacy.
• Intraoperative bleeding is a key challenge in FESS, with various methods employed to manage it.

Purpose of the Study:

• To evaluate the effectiveness of peri-operative tranexamic acid in improving operative parameters during FESS for chronic rhinosinusitis.
• To compare tranexamic acid (topical, oral, or intravenous) against placebo or no therapy in patients undergoing FESS.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searched multiple databases including Cochrane ENT, CENTRAL, MEDLINE, Embase, Web of Science, and clinical trial registries.
• Included 14 RCTs involving 942 adult and pediatric patients undergoing FESS, comparing tranexamic acid with placebo.

Main Results:

• Tranexamic acid significantly reduced surgical field bleeding scores (moderate-certainty evidence).
• A slight reduction in intraoperative blood loss and surgery duration was observed (low- to moderate-certainty evidence).
• No significant increase in immediate adverse events like seizures or thromboembolism was noted (moderate-certainty evidence).

Conclusions:

• Tranexamic acid demonstrates a beneficial effect on surgical field bleeding during FESS for chronic rhinosinusitis.
• Evidence suggests potential benefits in reducing blood loss and surgery time, with no increased immediate risks.
• Further research is needed to establish long-term safety and impact on incomplete surgery or complications.