Local Tranexamic Acid vs Placebo in Patients Undergoing Septorhinoplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Systemic tranexamic acid (TXA) reduces bleeding in nasal surgery but carries theoretical systemic risks. Topical TXA is an alternative, yet its efficacy in rhinoplasty and septoplasty is controversial because of inconsistent findings in individual trials. The aim of the authors of this systematic review and meta-analysis is to synthesize the evidence on the effectiveness of topical TXA in this setting. A systematic literature search was conducted from inception to July 2025 for randomized controlled trials (RCTs) comparing topical TXA to control in adults undergoing rhinoplasty, septoplasty, or septorhinoplasty. Primary outcomes included intraoperative blood loss, postoperative edema, and ecchymosis. Data were pooled using a random-effects model. Seven RCTs comprising 514 patients were included. The use of topical TXA was associated with a significant reduction in intraoperative blood loss (standardized mean difference [SMD] -1.20, 95% CI, -2.34 to -0.07; P = .04), overall postoperative edema (SMD -0.87, 95% CI, -1.35 to -0.39; P < .001), and ecchymosis (SMD -1.16, 95% CI, -1.63 to -0.69; P < .001). Secondary outcomes, such as surgeon satisfaction (SMD 0.74, 95% CI, -0.24 to 1.73, P = .14) and operative time (SMD -1.03, 95% CI, -2.69 to 0.62, P = .22), showed no statistically significant differences between the groups. In patients undergoing rhinoplasty or septoplasty, topical TXA significantly reduces intraoperative blood loss and postoperative edema and ecchymosis. These findings suggest it may serve as an effective adjunct for improving hemostasis and postoperative recovery. Level of Evidence: 3 (Therapeutic).