Tranexamic Acid and Rhinoplasty: How Do Different Administration Routes Affect Effectiveness?

Overview

Tranexamic acid reduces bleeding by slowing clot breakdown, but it can be given by vein, by mouth or applied topically, and the routes had not been compared directly. The authors ran a randomized double blinded study at one university clinic from April 2021 to April 2022, comparing all three routes against a control group.

Sections of note

• Design: randomized, double-blinded, prospective study. Level of evidence I.
• 146 patients in four groups: intravenous, oral, topical and control.
• Bleeding volume was measured in the suction chamber and nasopharyngeal pack; swelling and bruising were scored at the end of surgery and on days 1, 3 and 7.
• Operation time did not differ between groups, p equal to 0.894.
• Bleeding during surgery was significantly lower in the oral group than in all other groups, p equal to 0.020.
• The topical group had significantly less swelling than the other groups at the end of surgery and on days 1, 3 and 7, all p less than 0.05.
• The topical group had significantly less bruising at the end of surgery, p equal to 0.013, and on day 3, p equal to 0.024, with non-significant reductions on days 1 and 7.

What it means for a patient

• The route matters. Applying the drug locally reduced visible swelling and bruising, while taking it by mouth reduced blood loss during the operation.
• Swelling and bruising are what a patient sees in the mirror during recovery, so the topical route addresses that directly.
• No route shortened the operation.
• Limits: single centre, 146 patients across four groups, follow up only to day 7, and no adverse events from the drug reported in the abstract.

Why this paper matters

Tranexamic acid has been shown repeatedly to help in rhinoplasty, but studies used different routes and doses, which is a known source of disagreement between trials. Comparing routes head to head in a randomized design addresses that directly. Whether the topical benefit persists beyond one week is not shown.

Terms

• Tranexamic acid: a drug that slows clot breakdown, reducing bleeding.
• Intravenous: given into a vein.
• Topical or local application: applied directly to the tissue at the surgical site.
• Edema: swelling caused by fluid collecting in tissue.
• Ecchymosis: bruising, the discoloration from blood under the skin.
• Double-blinded: neither the patients nor the assessors know which treatment was given.