Conservation of blood is important in all forms of surgery and approximately 30% of patietns undergoing bimaxillary osteotomies require a transfusion. The aim of this trial was to assess the effect of tranexamic acid on blood loss, quality of surgical field and duration of surgery compared to the effect of nitroglycerin induced moderate hypotension alone

Patients aged 17–30 years scheduled for orthognathic surgery were randomised to receive tranexamic acid (10 mg/kg as a bolus preoperatively followed by 1 mg/kg as a maintenance dose intra operatively) or placebo (0.9% normal saline). All patients received moderate hypotensive anaesthesia with nitroglycerin and had surgery according to a standard protocol. Intra operative blood loss, duration of surgery, quality of surgical field, blood transfusion and complications, if any, were recorded.

They found

• statistically significant reduction in blood loss (p < 0.001)
• mean total blood loss was 166.1 ± 65.49 ml in the study group compared with 256.4 ± 77.80 ml in the control group.
• improved quality of surgical field (p < 0.001) in the study group.
• Surgical field rating scores in the study group (1.33 ± 0.33) compared with the control group (2.38 ± 0.53).
• no significant difference in duration of surgery and transfusion requirements between the two groups.

The authors  concluded

preoperative and intra operative administration of the antifibrinolytic agent, tranexamic acid, is effective in controlling blood loss and improving the quality of the surgical field

Sankar D, Krishnan R, Veerabahu M, Vikraman B. Evaluation of the efficacy of tranexamic acid on blood loss in orthognathic surgery. A prospective, randomized clinical study. Int J Oral Maxillofac Surg. 2012 Feb 14. [Epub ahead of print]PubMed PMID: 22340993.

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An earlier trial by Choi  et al 2009 found reductions in blood loss using an intravenous bolus dose of 20mg/kg, and systematic reviews in orthopaedic surgery( Sukeik et al 2011, Alshryda et al 2011) have also noted reduced blodd loss with tranexaminc acid use.

 Choi WS, Irwin MG, Samman N. The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg. 2009 Jan;67(1):125-33. PubMed PMID: 19070758.

Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br.2011 Jan;93(1):39-46. Review. PubMed PMID: 21196541.

Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011 Dec;93(12):1577-85. Review. PubMed PMID: 22161917.