Hemostatic effect of tranexamic acid in elective nasal surgery

E Yaniv, J Shvero, T Hadar

Am J Rhinol 20:227-229, 2006

SET1 angus shao

intro

• bleeding in FESS/ turbinoplasty/ setpoplasty

• intraoperatively or postoperatively

• may prevent completion of sugery

• may require packing inconveint for both patient and surgeon

tranexamic acid

• synthetic derivative of amino acid lysine

• antifibrinolytic effect on plasminogen

• reversible blockade

• inhibits conversion of plasminogen to plasmin, hence prevents breakdown of clot

• increases collagen synthesis which preserves the fibrin matrix and increases the tensile strength of the clot

tranexamic acid

• widely used in O&G, cardiac surgery, oral surgery, liver transplant and urology.

• route of administration:– oral– IV– topical

• theoretical risk of increased thrombotic tendency no evidence of increased risk of thrombotic tendency found in Cochrane meta-analysis

The paper

• Material and methods:– Prospective study– 400 patients; first 200 placebo, remaining 200

with oral tranexamic acid. (3g daily for 5/7, starting 2 hr pre-op)

The paper

discussion

• not RCT design.

• good number for statistical analysis

• same surgeon, same technique– Less confounding– ?observation biases?

discussion

• oral administration of tranexamic acid• ?IV or topical• Limited publication on tranexamic acid on

FESS/septorhino/turbinoplasty• P.J Wormald’s pilot study

– Published in 2007. – Topical TA, RCT of 30 “nostrils”– Significant difference in surgical field

intraoperative

discussion

• N Bodenstein’s audit• injection to greater platatine • two surgicel with topic tranexamic acid• stat dose of IV tranexamic acid

– ~80 patients, 40 received above, 40 had no topical or IV tranexamic acid

– significant reduction in overnight stay, and bolster used

– no adverse outcome

conclusion

• Evidence suggest no adverse outcome for using TA IV, oral or topically

• Small pilot RCT improved surgical field

• Retrospective study reduced bleeding intra and post-operatively

• Clinical audit significant reduction in bleed rate

• ?efficacy/cost