Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial

Vaghardoost R, Ahmadi Dahaj A, Haji Mohammad M, Ghadimi T, Forghani SF, Naderi Gharahgheshlagh S.

PubMed 37452132 Publisher (DOI)Free full text (PMC)

What this paper says

In 50 randomised primary rhinoplasty patients, injecting tranexamic acid (10 mg/kg) locally into the surgical field reduced intraoperative bleeding and swelling and bruising at days 1 and 7 with no complications.

Overview

Tranexamic acid is usually given intravenously; this Iranian trial tested local injection into the operative field. Fifty patients were randomised to local TXA or no injection, with the same anaesthesia for all. Bleeding volume and day-1 and day-7 oedema and ecchymosis were recorded and compared with Fisher and Mann-Whitney tests.

Sections of note

50 patients, two groups.
Intraoperative bleeding significantly lower with local TXA (P < 0.001).
Oedema on days 1 and 7 significantly lower with TXA (P < 0.001).
Ecchymosis also reduced per the conclusion.
No complications during surgery or follow-up. Level of Evidence III (as assigned despite randomisation).

What it means for a patient

Local tranexamic acid gave less bleeding during surgery and a less swollen, less bruised first week.
No side effects were seen in this small trial.
The control group received no injection at all rather than a saline placebo, so blinding was limited.

Why this paper matters

It supports a local route for a widely used haemostatic drug. Limits: 50 patients, no placebo, single centre, unblinded control.

Terms

Tranexamic acid (TXA): a drug that prevents blood clots from breaking down.
Local injection: delivered directly into the tissue being operated on.
Oedema: swelling; ecchymosis: bruising.
Mann-Whitney test: a statistical test for comparing two groups with non-normal data.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background And Aims: The purpose of this study was assessing the effect of local injection of tranexamic acid (TXA) on the amount of bleeding during the primary rhinoplasty and edema and ecchymosis following the surgery.

Methods: In this randomized clinical trial, 50 patients applying for primary rhinoplasty were divided into two groups of intervention and observation. In the intervention group, 10 mg/kg of TXA was injected locally to the operation field. In the observation group, no medicine was injected. The same anesthesia technique was used during the operation for all the patients. Age, sex, blood pressure, bleeding amount during the operation, the amount of edema and ecchymosis on the first and seventh day after the surgery were noted. The data were analyzed by the SPSS software version 24 and using descriptive statistics of frequency and percentage of frequency and Fisher and Mann-Whitney's exact statistical tests.

Results: Our results showed that there was a significant difference between the amounts of bleeding during the surgery between two groups (P-value < 0.001). Also, the postoperative edema on the first and seventh day in intervention group was less than the observation group (P-value < 0.001). There were no complications during the surgery and in the follow-up of the patients.

Conclusion: We revealed that local injection of TXA during the rhinoplasty procedure and decreased the intraoperative bleeding and postoperative ecchymosis and edema without any side effects and complications.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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