Intravenous Tranexamic Acid for Control of Bleeding during External Dacryocystorhinostomy under General Anesthesia: A Randomized Clinical Trial.

Purpose: To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia.

Methods: This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups.

Results: The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 $\pm$ 10.8 years and 58.06 $\pm$ 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 $\pm$ 9.52 minutes vs intervention: 26.03 $\pm$ 10.5 minutes; P $<$ 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 $\pm$ 48.19 ml) and control (47.74 $\pm$ 60 ml) groups (P $<$ 0.001).

Conclusion: Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.