Murphy, G.R., Glass, G.E., & Jain, A. (2016). The efficacy and safety of tranexamic acid in cranio-maxillofacial and plastic surgery. The Journal of Craniofacial Surgery, 27, 374–379. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the current literature related to the efficacy and safety of tranexamic acid in craniomaxillofacial, head and neck, breast, aesthetic, burns, and plastic surgery

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials
 
INCLUSION CRITERIA: Randomized, controlled trials of tranexamic acid compared to placebo or no tranexamic acid, given in a plastic surgery setting; adult and pediatric studies
 
EXCLUSION CRITERIA: Published abstracts, prospective comparative and case-controlled studies

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 8,304, 7,965 after duplicates were removed
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two authors conducted the abstract review. A full-text review was conducted on those that met inclusion criteria. Risk of bias assessment with Cochrane Collaboration tool

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 studies included, 7 for meta-analysis (head and neck and breast not included in meta-analysis)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 288 for meta-analysis
  • SAMPLE RANGE ACROSS STUDIES: Of the total studies considered, 14, including 908 patients, met inclusion criteria. Of those in this group, subspecialties included craniofacial, orthognathic, head and neck, breast, and aesthetic surgery.
  • KEY SAMPLE CHARACTERISTICS: Four trials for craniofacial and three trials for orthognathic surgery

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

APPLICATIONS: Pediatrics

Results

In the craniofacial studies, tranexamic acid use led to reduced blood loss (p = 0.00001) and a reduction in transfusion requirements (p = 0.00001). In the orthognathic studies, tranexamic acid use led to reduced blood loss (p = 0.01). In the head and neck trial, tranexamic acid led to a reduction in mean volume of drainage (p = 0.041). In the breast trial, tranexamic acid led to a reduction in drainage volume (p < 0.001). No complications were reported with the use of tranexamic acid in any of the included trials.

Conclusions

Tranexamic acid reduces blood loss and reduces the need for blood transfusions in craniofacial surgery. It reduces blood loss in orthognathic surgery and may reduce the drainage volumes in head and neck and breast surgeries.

Limitations

  • Limited number of studies included
  • Mostly low quality/high risk of bias studies
  • The head and neck study was underpowered.
  • The breast trial’s protocol was not described well, with risk of bias.  
  • Other agents used (ESA), other management strategies (blood pressure control, positional strategies), dosing differences, and so forth

Nursing Implications

Nurses involved in the surgical management of patients with cancer could consider the benefits of tranexamic acid in reducing drainage volumes in patients with head and neck or breast cancer. However, the articles did not draw clear correlations with the type of surgery and the presence of cancer. No significant finding was reported in these two populations related to the prevention of bleeding during or following surgical procedures.

Legacy ID

6342