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

Abstract

Background: Perioperative bleeding is a challenge in rhinoplasty and septoplasty. Tranexamic acid (TXA) may help reduce this, but its effectiveness is unclear. This systematic review and meta-analysis aimed to evaluate TXA's impact on bleeding in these procedures.

Methods: The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized controlled trials of adult patients undergoing rhinoplasty or septoplasty. Primary outcomes were intraoperative blood loss, surgery duration, and surgeon satisfaction. A random-effects model was used. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane's RoB 2 tool for randomized studies.

Results: The search yielded 154 results; 11 randomized controlled trials, with 968 patients, were included. The meta-analysis showed a significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24; P = 0.002) and superior surgeon satisfaction in favor of TXA use (SMD -2.73; 95% CI: -5.33 to -0.12; P = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, were also in favor of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; P = 0.02) and oral TXA (MD -44.98; 95% CI: -83.66 to -6.31; P = 0.02); no statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; P = 0.23). All studies were found to be of high quality, with low bias.

Conclusions: The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.

Fig. 1.

PRISMA flow diagram: illustrates the stages of article selection for this systematic review, from initial database search to final study inclusion, with numbers at each stage.

Fig. 2.

A forest plot comparing intraoperative blood loss across studies comparing this outcome with a placebo or standard practice.

Fig. 3.

A forest plot comparing the duration of surgery across studies comparing this outcome with placebo or standard practice.

Fig. 4.

A forest plot comparing surgeon satisfaction across studies comparing this outcome with a placebo or standard practice.

Fig. 5.

A forest plot comparing intraoperative blood loss across studies comparing this outcome using IV TXA with a placebo or standard practice.

Fig. 6.

A forest plot comparing intraoperative blood loss across studies comparing this outcome using oral TXA with a placebo or standard practice.

Fig. 7.

A forest plot comparing intraoperative blood loss across studies comparing this outcome using topical TXA with a placebo or standard practice.