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Intravenous Tranexamic Acid in Rhinoplasty: A Randomized Controlled Trial
Elizabeth S Longino1, Nicole G Desisto1, Feyi Adegboye1
1Otolaryngology & Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Facial Plastic Surgery & Aesthetic Medicine
|March 5, 2025
Summary
Intravenous tranexamic acid (TXA) did not reduce bleeding, swelling, or bruising in septorhinoplasty patients. This randomized trial found no significant differences between TXA and placebo groups for surgical outcomes or patient experience.
Area of Science:
- Plastic Surgery
- Anesthesiology
- Pharmacology
Background:
- Existing research on tranexamic acid (TXA) efficacy in rhinoplasty yields conflicting results.
- There is a need for robust clinical trials to clarify TXA's role in septorhinoplasty.
- This study addresses the mixed evidence regarding TXA's impact on surgical outcomes in rhinoplasty.
Purpose of the Study:
- To compare intraoperative blood loss, postoperative edema, and bruising in septorhinoplasty patients receiving intravenous (IV) TXA versus those receiving standard care.
- To evaluate the effectiveness of IV TXA in mitigating common complications of septorhinoplasty.
- To provide clear data on TXA's utility in open septorhinoplasty procedures.
Main Methods:
- A randomized controlled trial (NCT05774717) involving 139 patients undergoing open septorhinoplasty.
- Participants were randomized to receive either 1g IV TXA preoperatively or a placebo (routine medications only).
- Blood loss was quantified using the Boezaart scale and sponge saturation; edema and ecchymosis were assessed via patient self-reporting and blinded surgeon grading of photographs.
Main Results:
- No statistically significant differences were observed in Boezaart scores (2.25 vs. 2.41, p=0.3) or sponge saturation scores (0.76 vs. 0.84, p=0.4) between the TXA and control groups.
- Patient-reported and surgeon-graded assessments of periorbital edema and ecchymosis showed no significant variations between the groups.
- There were no reported differences in epistaxis, pain levels, or patient satisfaction with appearance between the TXA and control cohorts.
Conclusions:
- The administration of intravenous tranexamic acid (TXA) did not demonstrate a significant benefit in reducing blood loss, edema, or bruising following septorhinoplasty.
- TXA showed no discernible impact on key postoperative outcomes, including pain and patient satisfaction.
- Based on this trial, routine use of IV TXA in septorhinoplasty is not supported for improving surgical results or patient experience.
