Tranexamic Acid in Patients Undergoing Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Overview

Tranexamic acid is a drug that slows the breakdown of blood clots, reducing bleeding. Its role in rhinoplasty has been studied in scattered trials. The authors pooled the randomized evidence, assessing blood loss, swelling, bruising, operating time and surgeon satisfaction.

Sections of note

• Design: systematic review and meta-analysis of randomized controlled trials. Level of evidence I.
• 11 studies covering 841 patients were included.
• Total blood loss fell by a mean of 39.37 millilitres across all doses and routes, 95 percent confidence interval 62.70 to 16.05 millilitres, p equal to 0.0009, with high heterogeneity at I squared 92 percent.
• Intravenous 10 mg per kg before surgery reduced blood loss by 16.30 millilitres; 1 gram of oral tranexamic acid before surgery reduced it by 61.70 millilitres, the latter with no heterogeneity.
• Swelling on day one fell by 0.78 points and bruising by 1.13 points, both statistically significant.
• Surgeon satisfaction increased, standardized mean difference 1.55, p equal to 0.01.
• Operating time did not differ, p equal to 0.09.

What it means for a patient

• The drug reduces bleeding during the operation and the swelling and bruising visible the next day.
• The absolute reduction in blood loss is small, around 40 millilitres, which matters more for the surgeon's view of the field than for the patient's blood count.
• Oral dosing before surgery showed the largest and most consistent effect in this pooled data.
• Limits: heterogeneity was very high for most outcomes, meaning the trials disagreed considerably, and the abstract reports no adverse events from the drug.

Why this paper matters

Bruising and swelling shape the recovery experience and how soon a patient can be seen in public, and few interventions affect both. Pooled randomized evidence puts this on firmer ground than most rhinoplasty topics. Safety across patient groups, and the effect beyond the first postoperative day, are not covered here.

Terms

• Tranexamic acid: a drug that slows clot breakdown, reducing bleeding.
• Meta-analysis: statistical pooling of results from multiple studies.
• Mean difference: the average difference in an outcome between treated and untreated groups.
• Confidence interval: the range within which the true value most likely lies.
• I squared: a measure of how much studies disagree with each other.
• Periorbital: located around the eye.