Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty: A Systematic Review and Meta-analysis

McGuire C, Nurmsoo S, Samargandi OA, Bezuhly M.

PubMed 30605219 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 4 randomized trials with 271 patients, tranexamic acid reduced blood loss during rhinoplasty by a mean of 41.6 mL, and three studies also showed less bruising and swelling afterward.

Overview

Tranexamic acid slows the breakdown of blood clots and is used across surgery to reduce bleeding. This systematic review and meta-analysis assessed its effect in first-time elective rhinoplasty, on blood loss during the operation and on bruising and swelling afterward.

Sections of note

Searches of Medline, Embase and Google Scholar from inception to June 30, 2018, with references of included articles screened.
Population: adults having primary elective rhinoplasty; intervention tranexamic acid; control placebo.
5 studies with 332 patients were included qualitatively, all randomized clinical trials published within the previous 5 years.
Mean patient age 27 years SD 7, range 16 to 42; mean sample size 66 SD 19, range 50 to 96.
Meta-analysis of 4 studies with 271 patients: mean reduction in intraoperative blood loss of 41.6 mL, 95% CI -69.8 to -13.4 mL, P .004.
Three studies showed reduced postoperative swelling and bruising with tranexamic acid, but no significant difference compared with corticosteroid use.
Four studies were rated high methodological quality with low risk of bias; overall quality of evidence was rated high. Level of evidence 4.

What it means for a patient

Tranexamic acid reduced blood loss during the operation by roughly 42 mL on average, a modest absolute amount.
It also reduced bruising and swelling, but performed no better than a corticosteroid, which is the more familiar alternative.
The evidence rests on 5 small randomized trials in young adults.
Limits: total pooled sample of 332 patients, English-language studies only, and no data on side effects in the abstract.

Why this paper matters

Bruising and swelling determine how quickly patients return to normal activity, and several agents compete to reduce them. This pools the randomized evidence for one of them. The finding that it does not beat corticosteroids leaves the choice between agents open.

Terms

Tranexamic acid: A drug that slows the breakdown of blood clots, reducing bleeding.
Antifibrinolytic: A drug that prevents clots from dissolving.
Meta-analysis: Statistically combining results from multiple studies.
Risk of bias: An assessment of how likely a study's design is to have distorted its result.
GRADE: A system for rating the overall certainty of a body of evidence.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss.

Objective: To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.

Data Sources: A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications.

Study Selection: The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included.

Data Extraction And Synthesis: The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size.

Main Outcomes And Measures: The primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis.

Results: Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 (7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of -41.6 mL (95% CI, -69.8 to -13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high.

Conclusions And Relevance: Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.

Level Of Evidence: 4.

Abstract as indexed by PubMed; the article is open access (PubMed Central).