A systematic review on the efficacy of tranexamic acid in head and neck surgery
Jamshaid, Warda Jamshaid, Maryam Coulson, Chris Sharma, Neil Muzaffar, Jameel Nieto, Hannah
Jamshaid, Warda
Jamshaid, Maryam
Coulson, Chris
Sharma, Neil
Muzaffar, Jameel
Nieto, Hannah
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11/04/2023
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Abstract
Background: Intraoperative and postoperative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intraoperative and postoperative bleeding, however reported results are variable.
Objectives: To determine the safety and efficacy of TXA use in H&N surgery.
Methods: Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey, and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of postoperative drain or return to theatre rate for postoperative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for randomised controlled trials and Newcastle-Ottawa Scale tool for non-randomised studies.
Results: Sixteen studies were identified (114 407 patients). Eight studies evaluated TXA in major H&N surgery and eight studies in tonsillectomy. Primary outcomes were reduction in intraoperative or postoperative bleeding. Secondary outcomes included the duration of postoperative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intraoperative blood loss in tonsillectomy. However, the effect on posttonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases.
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Jamshaid W, Jamshaid M, Coulson C, Sharma N, Muzaffar J, Nieto H. A systematic review on the efficacy of tranexamic acid in head and neck surgery. Clin Otolaryngol. 2023 Jul;48(4):527-539. doi: 10.1111/coa.14059. Epub 2023 Apr 11.
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