Significant blood loss can occur during orthognathic surgery and there are risks associated with blood transfusion so minimizing blood loss during surgery is important. A large number of trials and reviews have shown that the antifibrinolytic agent tranexamic acid ( a synthetic amino acid lysine analog ) can effectively reduce bleeding in a number of surgical fields. The aim of this review was to determine whether tranexamic acid significantly reduces blood loss in orthognathic surgery.
The PubMed and Embase databases were searched together with the reference lists of identified articles. Placebo controlled randomised controlled trials (RCTs) were included. Independent data extraction was conducted by 2 reviewers with study quality being assessed using the Jadad scale.
- 4 RCTs involving a total of 183 patients were included
- Tranexamic acid produced a statistically significant reduction in intraoperative blood loss
- There was no difference in postoperative levels of Haemoglobin and Haematocrit compared with placebo.
The authors concluded
This meta-analysis confirms that tranexamic acid can effectively reduce intraoperative blood loss in orthognathic surgery, especially by intravenous administration. But, tranexamic acid cannot affect postoperative levels of haemoglobin and haematocrit.
Comment
There is an extensive literature on tranexamic acid and its effect on blood loss during surgery. A quick and dirty search on Medline using just a combination of the terms; tranexamic acid, blood loss, surgery and systematic review had 80 hits and there are 23 Cochrane reviews on the Cochrane Library . The 2011 Cochrane review by Henry et al looked at antifibrinolytics for reducing blood transfusion in elective surgery. That review included only one orthognathic surgery paper which looked at the use of aprotinin. The Henry review included 252 RCTs involving over 25,000 participants concluding:-
Anti-fibrinolytic drugs provide worthwhile reductions in blood loss and the receipt of allogeneic red cell transfusion. Aprotinin appears to be slightly more effective than the lysine analogues in reducing blood loss and the receipt of blood transfusion. However, head to head comparisons show a lower risk of death with lysine analogues when compared with aprotinin. The lysine analogues are effective in reducing blood loss during and after surgery, and appear to be free of serious adverse effects.
One of the trial included in this review we highlighted in the Dental Elf in March of last year (Dental Elf Mar 29th).
Links
Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q. The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Dec 20. doi:pii: S2212-4403(12)01625-2. 10.1016/j.oooo.2012.09.085. [Epub ahead of print] PubMed PMID: 23260768.
Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA, Ker K. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD001886. DOI: 10.1002/14651858.CD001886.pub4.
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