The effectiveness of intravenous tranexamic acid on blood loss and surgical time during endoscopic sinus surgery: A systematic review

ABSTRACT

@#<p style="text-align justify;"><strong>OBJECTIVE:</strong> To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis  (CRS).<br /><strong>METHODS:</strong> <br /> <strong>Data Sources</strong> MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library.<br /><strong> Eligibility Criteria </strong>Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of   tranexamic  acid or placebo in patients undergoing ESS for CRS.<br /> <strong>Appraisal and Synthesis Methods:</strong> Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization).<br /><strong>RESULTS:</strong> Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (Cl95 [-59.44, -42.95]) showing that the blood loss in millimeters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32   (Cl95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution.  The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales.<br /><strong>LIMITATIONS:</strong> The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. <br /><strong>CONCLUSION:</strong> Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in the study, however, results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss  as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS.<br /><br /><br /><br />               </p>