Tranexamic Acid in Rhinoplasty and Septoplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Khajuria A, Khademi Mansour HR, Muhammad I, Asare A, Tammasse I, Suresh J, Leiberman C, Pacheco-Barrios N, Brown S, Dogan T, Rohrich R.

PubMed 39507311 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 11 randomized trials covering 968 patients, tranexamic acid reduced blood loss during rhinoplasty and septoplasty by a mean of 39.67 millilitres and improved surgeon satisfaction.

Overview

Bleeding during rhinoplasty and septoplasty obscures the surgical field, and tranexamic acid may reduce it. The authors registered their protocol in advance with PROSPERO and searched PubMed, Embase, Google Scholar and Web of Science from inception to October 2023, including only randomized controlled trials in adults.

Sections of note

Design: systematic review and meta-analysis of randomized trials, registered a priori. A random-effects model was used.
Quality was assessed with GRADE and risk of bias with the Cochrane RoB 2 tool. All included studies were rated high quality with low bias.
The search yielded 154 results; 11 randomized trials with 968 patients were included.
Blood loss during surgery fell by a mean of 39.67 millilitres, 95 percent confidence interval 15.10 to 64.24, p equal to 0.002.
Surgeon satisfaction favored the drug, standardized mean difference minus 2.73, p equal to 0.04.
By route: intravenous reduced blood loss by 13.02 millilitres, p equal to 0.02; oral by 44.98 millilitres, p equal to 0.02.
Operating time did not differ, p equal to 0.23.

What it means for a patient

The drug reduces bleeding during the operation, which mainly helps the surgeon see clearly rather than affecting the patient's blood count.
Oral dosing before surgery produced a larger reduction than intravenous in this pooled analysis, consistent with other reviews.
The operation did not get shorter, so the benefit is field visibility rather than speed.
Limits: the abstract reports no swelling or bruising outcomes, and no adverse events from the drug are given.

Why this paper matters

Rhinoplasty has few interventions supported by pooled randomized evidence, and this is one. Prior registration, formal bias assessment and a uniformly high quality set of trials make the estimate more trustworthy than most in this field. What patients experience afterward, swelling and bruising, is not covered by these outcomes.

Terms

Tranexamic acid: a drug that slows clot breakdown, reducing bleeding.
Septoplasty: surgery to straighten the wall dividing the two sides of the nose.
Meta-analysis: statistical pooling of results from multiple studies.
PROSPERO: a public register where systematic review plans are recorded in advance.
GRADE: a system for rating the certainty of evidence.
Confidence interval: the range within which the true value most likely lies.

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

Abstract

Background: Perioperative bleeding is a challenge in rhinoplasty and septoplasty. Tranexamic acid (TXA) may help reduce this, but its effectiveness is unclear. This systematic review and meta-analysis aimed to evaluate TXA's impact on bleeding in these procedures.

Methods: The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized controlled trials of adult patients undergoing rhinoplasty or septoplasty. Primary outcomes were intraoperative blood loss, surgery duration, and surgeon satisfaction. A random-effects model was used. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane's RoB 2 tool for randomized studies.

Results: The search yielded 154 results; 11 randomized controlled trials, with 968 patients, were included. The meta-analysis showed a significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24; P = 0.002) and superior surgeon satisfaction in favor of TXA use (SMD -2.73; 95% CI: -5.33 to -0.12; P = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, were also in favor of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; P = 0.02) and oral TXA (MD -44.98; 95% CI: -83.66 to -6.31; P = 0.02); no statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; P = 0.23). All studies were found to be of high quality, with low bias.

Conclusions: The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.

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