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

IF 1.5 Q3 SURGERY Plastic and Reconstructive Surgery Global Open Pub Date : 2024-11-05 eCollection Date: 2024-11-01 DOI:10.1097/GOX.0000000000006275

Ankur Khajuria, Hamid Reza Khademi Mansour, Ibrahim Muhammad, Akua Asare, Iin Tammasse, Jonathan Suresh, Christopher Leiberman, Niels Pacheco-Barrios, Stav Brown, Teoman Dogan, Rod Rohrich

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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.

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氨甲环酸在鼻成形术和鼻中隔成形术中的应用：随机对照试验的系统回顾和元分析》。

背景：围手术期出血是鼻成形术和鼻中隔成形术中的一个难题。氨甲环酸（TXA）可能有助于减少出血，但其效果尚不明确。本系统综述和荟萃分析旨在评估氨甲环酸对这些手术中出血的影响：该方案已事先在 PROSPERO（CRD42023393458）上注册。检索了从开始到 2023 年 10 月的 PubMed、Embase、Google Scholar 和 Web of Science。符合条件的研究均为针对接受鼻成形术或鼻中隔成形术的成年患者进行的随机对照试验。主要结果为术中失血量、手术持续时间和外科医生满意度。采用随机效应模型。方法学质量采用 GRADE 进行评估。结果：结果：搜索结果共 154 项，其中包括 11 项随机对照试验，968 名患者。荟萃分析表明，使用TXA可显著降低术中失血量（MD -39.67；95% CI：-15.10 至 -64.24；P = 0.002），使用TXA的外科医生满意度更高（SMD -2.73；95% CI：-5.33 至 -0.12；P = 0.04）。根据给药途径对术中失血量进行的亚组分析也显示，静脉注射 TXA（MD -13.02；95% CI：-1.65 至 -24.38；P = 0.02）和口服 TXA（MD -44.98；95% CI：-83.66 至 -6.31；P = 0.02）对术中失血量更有利；手术持续时间无统计学差异（MD -0.99；95% CI：0.63 至 -2.81；P = 0.23）。所有研究的质量均较高，偏倚较低：研究结果表明，TXA 能有效减少鼻成形术和鼻中隔成形术中的失血量，外科医生的满意度也很高。

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来源期刊

Plastic and Reconstructive Surgery Global Open SURGERY-

CiteScore

2.20

自引率

13.30%

发文量

1584

审稿时长

10 weeks

期刊介绍： Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.