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Related Concept Videos

Epistaxis01:30

Epistaxis

136
Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
136

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Tranexamic Acid in Rhinoplasty and Septoplasty: A Systematic Review and Meta-analysis of Randomized Controlled

Ankur Khajuria1,2, Hamid Reza Khademi Mansour3, Ibrahim Muhammad4

  • 1From the Kellogg College, University of Oxford, Oxford, United Kingdom.

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Tranexamic acid (TXA) significantly reduces blood loss and improves surgeon satisfaction in rhinoplasty and septoplasty. This systematic review confirms TXA

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Area of Science:

  • Otolaryngology
  • Surgical Hemostasis
  • Pharmacology

Background:

  • Perioperative bleeding presents a significant challenge in rhinoplasty and septoplasty procedures.
  • The efficacy of tranexamic acid (TXA) in mitigating this bleeding remains incompletely understood.
  • This study addresses the need for a comprehensive evaluation of TXA's effectiveness in these specific surgeries.

Purpose of the Study:

  • To systematically review and meta-analyze the existing randomized controlled trials (RCTs) evaluating the impact of tranexamic acid (TXA) on perioperative bleeding.
  • To assess TXA's effect on intraoperative blood loss, surgery duration, and surgeon satisfaction in patients undergoing rhinoplasty and septoplasty.
  • To provide evidence-based recommendations regarding the use of TXA in these common surgical procedures.

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, Google Scholar, and Web of Science up to October 2023.
  • Included studies were randomized controlled trials involving adult patients undergoing rhinoplasty or septoplasty.
  • Data on intraoperative blood loss, surgery duration, and surgeon satisfaction were extracted and analyzed using a random-effects model. Methodological quality and risk of bias were assessed using GRADE and Cochrane's RoB 2 tool, respectively.

Main Results:

  • Eleven RCTs involving 968 patients were included in the meta-analysis.
  • Tranexamic acid demonstrated a significant reduction in intraoperative blood loss (MD -39.67; P = 0.002) and enhanced surgeon satisfaction (SMD -2.73; P = 0.04).
  • Subgroup analyses indicated benefits for both intravenous and oral TXA administration routes, with no significant impact on surgery duration (P = 0.23). All included studies were of high quality with low risk of bias.

Conclusions:

  • Tranexamic acid is effective in reducing intraoperative blood loss during rhinoplasty and septoplasty.
  • The use of TXA is associated with improved surgeon satisfaction in these procedures.
  • The findings support the routine consideration of tranexamic acid to optimize outcomes in rhinoplasty and septoplasty.