Comparison Between Oral and Intravenous Tranexamic Acid in Endoscopic Sinus Surgery
Abstract
Background: The goal of this study is to assess oral and intravenous administration of tranexamic acid's (TXA) on intra-operative bleeding during endoscopic sinus surgery and to compare with control group.
Methods: Forty-eight patients who were scheduled for endoscopic sinus surgery were chosen and randomly assigned to three groups. In first group 20mg/kg intravenous tranexamic acid, in second group 1000 mg 4 times daily for 48 hours and in third group 10 ml of normal saline were administered. The quality of the surgical field was estimated every 15 minutes by Boezaart scale. Volume of bleeding, pre and postoperative hematocrit, surgeon’s satisfaction by likert scale and duration of the surgical procedure were evaluated. Data was analyzed by SPSS v21 and P<0.05 was significant.
Results: Demographic parameters were not different among three groups. The surgical field quality at 15th minute was grade I-II in 25, 68.75 and 75 percent of the patients in the control, intravenous and oral groups, respectively. And also, no patients in the intervention groups and 42% of the patients in the control group were in grade IV. At 15 minute following surgery, there was a significant difference between the tranexamic groups and the control group (P = 0.002). at 30th minute 25, 50 and 56% of the patients in the control intravenous and oral groups, respectively were in grade I-II and difference was significant (P = 0.003). But at 45th minutes quality of surgical field was not different significantly (P = 0.163). The intraoperative average bleeding was 95.46, 94.32 and 190.64 ml for intravenous, oral and control patients that difference was significant (P = 0.001). The satisfaction of the surgeon was higher in the intravenous and oral TXA groups than the control group (P = 0.012). In comparison to the control group, the tranexamic group's surgical time were considerably lower (P 0.001). Hematocrits and drug side effects did not differ significantly among groups.
Conclusion: Systemic tranexamic acid (intravenous or oral) during endoscopic sinus surgery enhances surgical field quality, decreases intra-operative hemorrhage, and shortens operation duration.
[2] Bajwa SJS, Sehgal V. Anesthesia and thyroid surgery: The never ending challenges. Indian J Endocrinol Metab. 2013; 17(2):228-34.
[3] Schaefer SD. Endoscopic Sinus Surgery: Anatomy, Three-Dimensional Reconstruction, and Surgical Technique. Plastic and Reconstructive Surgery. 2009;124(2):658.
[4] Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 1990;247(2):63-76.
[5] Stammberger H. Endoscopic Endonasal Surgery—Concepts in Treatment of Recurring Rhinosinusitis. Part II. Surgical Technique. Otolaryngol Head Neck Surg. 1986; 94(2):147-56.
[6] Wormald PJ, Van Renen G, Perks J, Jones JA, Langton-Hewer CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol. 2005; 19(5):514-20.
[7] Jacobi KE, Böhm BE, Rickauer AJ, Jacobi C. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth. 2000; 12(3):202-7.
[8] Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anesth. 2011; 23(8):611-5.
[9] Ralley FE, Berta D, Binns V, Howard J, Naudie DD. One intraoperative dose of tranexamic Acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010; 468(7):1905-11.
[10] Brum MR, Miura MS, Castro SFd, Machado GM, Lima LH, Neto JFL. Tranexamic acid in adenotonsillectomy in children: A double-blind randomized clinical trial. Int J Pediatr Otorhinolaryngol. 2012; 76(10):1401-5.
[11] Longstaff C. Studies on the mechanisms of action of aprotinin and tranexamic acid as plasmin inhibitors and antifibrinolytic agents. Blood Coagul Fibrinolysis. 1994; 5(4):537-42.
[12] Wang W, Boffa MB, Bajzar L, Walker JB, Nesheim ME. A Study of the Mechanism of Inhibition of Fibrinolysis by Activated Thrombin-activable Fibrinolysis Inhibitor. J Biol Chem. 1998; 273(42):27176-81.
[13] Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol. 2007; 21(6):737-42.
[14] Jabalameli M, Zakeri K. Evaluation of Topical Tranexamic Acid on Intraoperative Bleeding in Endoscopic Sinus Surgery. Iran J Med Sci. 2006; 31(4) 221-223.
[15] Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995; 42(5):373-6.
[16] Crescenti A, Borghi G, Bignami E, Bertarelli G, Landoni G, Casiraghi GM, et al. Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: double blind, randomised, placebo controlled trial. BMJ. 2011; 343.
[17] Abrishami A, Chung F, Wong J. Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis. Can J Anaesth. 2009; 56(3):202-12.
[18] Tang YMJ, Chapman TWL, Brooks P. Use of tranexamic acid to reduce bleeding in burns surgery. J Plast Reconstr Aesthet Surg. 2012; 65(5):684-6.
[19] Kaewpradub P, Apipan B, Rummasak D. Does Tranexamic Acid in an Irrigating Fluid Reduce Intraoperative Blood Loss in Orthognathic Surgery? A Double-Blind, Randomized Clinical Trial. J Oral Maxillofac Surg. 2011; 69(6):e186-e9.
[20] Langille MA, Chiarella A, Côté DW, Mulholland G, Sowerby LJ, Dziegielewski PT, et al., editors. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double‐blind randomized controlled trial. International forum of allergy & rhinology; 2013; 3(4):315-8.
[21] K. Mottaghi FS, A. Salimi, S. Malek, N. Rahimi. Evaluation of intravenous Tranexamic acid effects on bleeding, duration of surgery and surgeon satisfaction in endoscopic sinus surgery. J Iran Anesth Crit Care Med Assoc Iran. 2010; 72: 14–29.
[22] Nuhi S, Goljanian Tabrizi A, Zarkhah L, Rashedi Ashrafi B. Impact of Intravenous Tranexamic Acid on Hemorrhage During Endoscopic Sinus Surgery. Iran J Otorhinolaryngol. 2015; 27(82):349-54.
[23] Eldaba AA, Amr YM, Albirmawy OA. Effects of tranexamic acid during endoscopic sinsus surgery in children. Saudi J Anaesth. 2013; 7(3):229-33.
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| Bleeding Anesthesia Endoscopic sinus surgery Tranexamic acid | ||
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