Tranexamic acid versus hot saline irrigations in endoscopic sinus surgery: a review and meta-analysis
DOI:
https://doi.org/10.34631/sporl.2054Keywords:
tranexamic acid, hot saline, endoscopic sinus surgery, blood loss, surgical field, duration, nasalAbstract
Objectives: Intraoperative bleeding may compromise the results of functional endoscopic sinus surgery (FESS). Tranexamic acid (TXA) and hot saline irrigations (HSI) are potentially useful in reducing blood loss during FESS. To date, no review comprehensively compared outcomes between TXA and HSI. The objective was to bring an insight between these two modalities in FESS.Study design: Systematic review and meta-analysis
Material and Methods: The research was performed across PUBMED and Cochrane collaboration databases. A meta-analysis was performed to allow the comparison between TXA and HSI outcomes in FESS.
Results: Twelve papers met the eligibility criteria for meta-analysis. HSI presented a more significant reduction in volumetric blood loss compared to TXA (p=0.01). No statistically significant difference was found between HSI and TXA considering surgical field quality (p = 0.99) and duration of surgery (p=0.24).
Conclusions: This study suggests similar efficacy of HSI and TXA in improving operative conditions in FESS.
References
Thongrong C, Kasemsiri P, Carrau RL, Bergese SD. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg. 2013 Jun 13;2013:191543. DOI: https://doi.org/10.1155/2013/191543.
Kang H, Hwang SH. Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia? Braz J Otorhinolaryngol. 2020 Jan-Feb;86(1):111-118. DOI: https://doi.org/10.1016/j.bjorl.2019.08.006.
Shehata A, Ibrahim MS, Abd-El-Fattah MH. Topical tranexamic acid versus hot saline for field quality during endoscopic sinus surgery. Egypt J Otolaryngol [Internet]. 2014;30(4):327–31. Available from: https://doi.org/10.4103/1012-5574.144965
Gan EC, Alsaleh S, Manji J, Habib AR, Amanian A, Javer AR. Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial. Int Forum Allergy Rhinol. 2014 Nov;4(11):877-84. DOI: https://doi.org/10.1002/alr.21376
Jabalameli M, Zakeri K. Evaluation of topical tranexamic acid on intraoperative bleeding in endoscopic sinus surgery. Irarian Journal of Medical Sciences. 2006 Dec; 31(4):221-223.
Nuhi S, Tabrizi AG, Zarkhah L, Ashrafi BR. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iran J Otorhinolaryngol. 2015 Sep;27(82):349-54.
Al-Ississ A, Al-Khaldi H, Maayah A. Kilani NK. Effect of warm saline on bleeding during sinus and septum surgery. J R Med Serv [Internet]. 2016 Mar;23(1):17–21. Available from: https://platform.almanhal.com/Files/2/82636
Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol. 2007 Nov-Dec;21(6):737-42. DOI: https://doi.org/10.2500/ajr.2007.21.3097.
Langille MA, Chiarella A, Côté DW, Mulholland G, Sowerby LJ, Dziegielewski PT. et al. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol. 2013 Apr;3(4):315-8. DOI: https://doi.org/10.1002/alr.21100
Dongare DH, Saundattikar GY. Comparison of intraoperative bleeding and surgical fields with and without tranexamic acid in functional endoscopic sinus surgery. Indian J Clin Anaesth. 2018;5(2):233–6. DOI: https://doi.org/10.18231/2394-4994.2018.0043.
Jahanshahi J, Hashemian F, Pazira S, Bakhshaei MH, Farahani F, Abasi R. et al. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One. 2014 Aug 18;9(8):e104477. DOI: https://doi.org/10.1371/journal.pone.0104477.
El Shal SM, Hasanein R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egypt J Anaesth [Internet]. 2015;31(1):1–7. Available from: https://www.sciencedirect.com/science/article/pii/S1110184914000695
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 Dec;23(8):611-5. DOI: https://doi.org/10.1016/j.jclinane.2011.03.004.
Eldaba AA, Amr YM, Albirmawy OA. Effects of tranexamic acid during endoscopic sinsus surgery in children. Saudi J Anaesth. 2013 Jul;7(3):229-33. DOI: https://doi.org/10.4103/1658-354X.115314.
Nagarajah D, Kueh YC, Lazim NM, Abdullah B. The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis. Syst Rev. 2022 Nov 18;11(1):246. DOI: https://doi.org/10.1186/s13643-022-02113-0.
Yap D, Shakir A, Hunt A. Tranexamic acid in sinus and nasal surgery: an up-to-date meta-analysis. J Laryngol Otol. 2022 Aug;136(8):692-702. DOI: https://doi.org/10.1017/S0022215121003170.
Pundir V, Pundir J, Georgalas C, Fokkens WJ. Role of tranexamic acid in endoscopic sinus surgery - a systematic review and meta-analysis. Rhinology. 2013 Dec;51(4):291-7. DOI: https://doi.org/10.4193/Rhino13.042.
Kim DH, Kim S, Kang H, Jin HJ, Hwang SH. Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: a meta-analysis and systematic review. Laryngoscope. 2019 Apr;129(4):800-807. DOI: https://doi.org/10.1002/lary.27766.
Ping WD, Zhao QM, Sun HF, Lu HS, Li F. Role of tranexamic acid in nasal surgery: a systemic review and meta-analysis of randomized control trial. Medicine (Baltimore). 2019 Apr;98(16):e15202. DOI: https://doi.org/10.1097/MD.0000000000015202.
Athanasiadis T, Beule A, Embate J, Steinmeier E, Field J, Wormald PJ. Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope. 2008 Feb;118(2):314-9. DOI: https://doi.org/10.1097/MLG.0b013e318157f764.
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 May;42(5 Pt 1):373-6. DOI: https://doi.org/10.1007/BF03015479.
Chhapola S, Matta I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. Clinical Rhinology: An International Journal [Internet] 2011 May-Aug; 4(2): 79-81. Available from: https://www.jaypeedigital.com/doi/AIJCR/pdf/10.5005/jp-journals-10013-1078
Stangerup SE, Dommerby HO, Lau T. [Hot water irrigation in the treatment of posterior epistaxis]. Ugeskr Laeger. 1996 Jul 1;158(27):3932-4.
Stangerup SE, Dommerby H, Siim C, Kemp L, Stage J. New modification of hot-water irrigation in the treatment of posterior epistaxis. Arch Otolaryngol Head Neck Surg. 1999 Jun;125(6):686-90. DOI: https://doi.org/10.1001/archotol.125.6.686.
Stangerup SE, Thomsen HK. Histological changes in the nasal mucosa after hot-water irrigation. An animal experimental study. Rhinology. 1996 Mar;34(1):14-7.
Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. Keio J Med. 2009 Sep;58(3):152-60. DOI: https://doi.org/10.2302/kjm.58.152.
Robb PJ. Tranexamic acid - a useful drug in ENT surgery? J Laryngol Otol. 2014 Jul;128(7):574-9. DOI: https://doi.org/doi: 10.1017/S0022215114001285.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
