de A. de Vasconcellos SJ, et al. - The researchers carried out a systematic review and meta-analysis to examine the outcomes of tranexamic acid use to decrease intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty. In patients undergoing rhinoplasty, preoperative administration of tranexamic acid is safe and might lessen intraoperative bleeding and in addition postoperative eyelid edema and ecchymosis.

Methods

• Researchers searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017 for this systematic review.
• They included key words tranexamic acid, rhinoplasty, and nasal surgical procedures.
• They used the following elements to characterize eligibility criteria:
  • population: patients undergoing rhinoplasty surgery;
  • intervention and controls: tranexamic acid vs placebo solution or no-treatment control group;
  • outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events;
  • study type: randomized clinical trials.
• According to the Cochrane guidelines for randomized clinical trials, 2 reviewers extracted data and assessed study quality.
• They characterized treatment effects as weighted mean difference (WMD) and 95% CIs.
• Using the Grading of Recommendations Assessment, Development, and Evaluation rating system, the strength of evidence was analyzed.
• Main outcomes were intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis.
• Means and SDs were obtained for each study group and outcome of interest to calculate the effect sizes.

Results

• As per data, 5 studies involving 276 subjects were incorporated in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years.
• In the meta-analysis, 4 studies involving 246 subjects estimated the amount in intraoperative bleeding as a primary outcome and were incorporated.
• Evaluated outcomes in 2 studies were eyelid edema and ecchymosis.
• Tranexamic acid was correlated with decreased bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P=.01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I² = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I² = 56%) administration.
• It was noted that eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08.
• No reports of thromboembolic events were found.