Effect of Tranexamic Acid on Inpatient Admission and Revision Rates in Primary Rhinoplasty: A Propensity Score-Matched Analysis

Mehdizadeh M, Smith JE, Gill J, Foster L, Cordero JJ, Taylor A, Schonebaum DI, Garbaccio N, Tobin M, Lin SJ.

PubMed 42028104 Publisher (DOI)Free full text (PMC)

What this paper says

In 1,627 matched pairs from a 133-million-record US database, patients given tranexamic acid during primary rhinoplasty had about half the odds of hospital admission within two weeks (OR 0.492) and of revision within a year (OR 0.441), with no increase in clotting complications.

Overview

Tranexamic acid is known to reduce bruising and swelling after rhinoplasty, but its effect on harder outcomes was unknown. The authors used the TriNetX database to compare primary rhinoplasty patients who received TXA during surgery with those who did not, matched on demographics, tobacco use and bleeding-related comorbidities.

Sections of note

1,639 TXA and 33,221 non-TXA patients identified; 1,627 per cohort after matching.
Inpatient admission within 2 weeks: OR 0.492 (P = 0.003).
Revision within 1 year: OR 0.441 (P < 0.028).
No difference in haemoglobin (P = 0.4) or emergency visits (P = 0.109).
No hematoma, embolism, thrombosis or vascular complications reported.

What it means for a patient

Tranexamic acid during rhinoplasty was associated with fewer admissions and fewer revisions in this large dataset.
The authors suggest the mechanism is a clearer surgical field allowing more precise work, since blood counts did not change.
Association in a database does not prove cause; surgeons who use TXA may differ in other ways.

Why this paper matters

It links a cheap, routine drug to revision rates for the first time at scale. Limits: retrospective database coding, unmeasured confounders, no information on dose or route.

Terms

Tranexamic acid (TXA): a drug that stabilises blood clots and reduces bleeding.
Propensity score matching: pairing treated and untreated patients with similar characteristics.
Odds ratio (OR): the relative odds of an event; 0.5 means half the odds.
TriNetX: a large network of de-identified electronic health records.
Thromboembolism: a clot that blocks a blood vessel, a theoretical risk of clot-promoting drugs.

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

Abstract

Background: Tranexamic acid (TXA) is commonly used to reduce intraoperative bleeding and complications across surgical specialties. In rhinoplasty, prior studies indicate that TXA may reduce postoperative edema and ecchymosis, but its effects on revision rates and inpatient admissions remain unclear. This study evaluated TXA's efficacy in improving perioperative outcomes in primary rhinoplasty, analyzing admission rates, revisions, and other postoperative events.

Methods: A retrospective cohort study was conducted using the TriNetX database of 133 million US medical records spanning 20 years. Patients undergoing primary rhinoplasty were identified, and outcomes up to 2 weeks postsurgery were compared between those administered TXA during rhinoplasty and those who were not. Revision rates within the first year were also analyzed. Propensity score-matching accounted for demographics, tobacco use, and comorbidities impacting bleeding risk.

Results: We identified 1639 TXA and 33,221 non-TXA rhinoplasty patients. After matching, 1627 remained in each cohort. TXA patients had significantly lower inpatient admissions within 2 weeks postoperatively (odds ratio 0.492; P = 0.003) and fewer revisions within a year (odds ratio 0.441; P < 0.028). No significant differences were found in mean hemoglobin levels (P = 0.4) or emergency department visits (P = 0.109). No incidences of hematoma, embolism, thrombosis, or vascular complications were reported.

Conclusions: Although TXA may not impact total blood loss enough to alter hemoglobin, its ability to minimize minor bleeding may improve intraoperative visibility, perhaps allowing for greater precision and reducing complication risks leading to revisions. Importantly, TXA did not increase adverse events, maintaining a favorable safety profile.

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