Evaluating the Effect of Intravenous Tranexamic Acid on Intraoperative Bleeding  During Elective Rhinoplasty Surgery

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Evaluating the Effect of Intravenous Tranexamic Acid on Intraoperative Bleeding During Elective Rhinoplasty Surgery

Volume 8, (october Spl Edition)

Mehdi Beikaei^1*, Ali Ghazipour², Vita Derakhshande³, Nader Saki² and Soheila Nikakhlagh²

¹Resident of otolaryngology, Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. ²Associated Professor of Otolaryngology, Head and Neck Surgery, Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. ³Assistant Professor of Otolaryngology, Head and Neck Surgery, Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

DOI : http://dx.doi.org/10.13005/bpj/779

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ABSTRACT:

Rhinoplasty is associated with intraoperative bleeding which affects the quality of operation and may increase surgery duration. This study is designed with the aim assessing the role of intravenous tranexamic acid (TA) on reduction of intraoperative bleeding during elective open rhinoplasty. This was a single center double blind randomized controlled trial (phase 2) conducted in Imam Khomeini Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences, one hundred candidates of elective rhinoplasty were randomly allocated to one treatment arm receiving a bolus 10mg/kg dose of intravenous TA (n=50) and one control group being administered with normal saline as the placebo (n=50). All subjects underwent open rhinoplasty under general anesthesia with the same surgical team using standard technique. The primary outcome measure was the estimated volume of intraoperative bleeding (measured in mL). Ninety six patients successfully completed the study (n=48 in each group). Unadjusted for covariates, the total volume of blood loss was 43.3±11.0 mL in the TA group while it was 60.3±9.5 mL in the control group (mean difference=16.9 mL, 95% CI [12.7-21.0], p<0.001). After controlling for the confounding effect of age, gender, weight and surgery duration on intraoperative blood loss, TA was associated with a 15.6 mL decrease (95% CI [11.8-19.4], p<0.001) in intraoperative bleeding. Considering the efficacy and safe therapeutic profile of tranexamic acid, we recommend a single bolus dose of intravenous TA (10mg/kg) upon anesthesia induction in order to achieve satisfactory hemostasis in healthy candidates of open rhinoplasty.

KEYWORDS:

Open Rhinoplasty; Tranexamic Acid; Intraoperative Bleeding