Impact of Intravenous Tranexamic Acid on Hemorrhage During Endoscopic Sinus Surgery | ||
| Iranian Journal of Otorhinolaryngology | ||
| مقاله 4، دوره 27، شماره 5، آذر 2015، صفحه 349-354 اصل مقاله (184.98 K) | ||
| نوع مقاله: Original | ||
| شناسه دیجیتال (DOI): 10.22038/ijorl.2015.4246 | ||
| نویسندگان | ||
| Saidollah Nuhi؛ ali goljanian* ؛ Leyla Zarkhah؛ bahram rashedi | ||
| Department of Otorhinolaryngology, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran. | ||
| چکیده | ||
| Introduction: Endoscopic sinus surgery is a common procedure performed by otolaryngologists. This study evaluated the efficacy of intravenous (IV) tranexamic acid (TA) on hemorrhage in patients undergoing elective endoscopic sinus surgery (ESS). Materials and Methods: The present study was performed in 170 patients scheduled for ESS surgery under general anesthesia in order to examine the effects of IV TA on providing a bloodless surgical field and to evaluate the amount of bleeding. One hundred patients received intravenous TA and 70 patients received placebo. Intraoperative hemorrhage was estimated by the attending anesthesiologist at the end of surgery by accounting for loss of blood and irrigation fluid in a 25 mL-graded suction canister and nasopharyngeal packing (measured weight of packing on the electronic scale). Hemodynamic variables were monitored and coagulation profile was determined. Results: A total of 170 patients (90 male [53%] and 80 female [47%]), mean age 30.54±4.14 years, were evaluated. There was a significantly lower bleeding volume in the TA group than in the placebo group (107.7±45.1 vs. 189.3±51 mL; P<0.001). There was no significant difference between pre- and postoperative hematocrit (38.81± 4.20 vs. 36.60± 3.35) or pre- and postoperative hemoglobin (12.51± 2.5 vs. 11.64±1.9) levels in the TA group (P>0.05). Moreover, the difference between the TA and control groups regarding postoperative hematocrit (34.65±4.45 vs. 36.60±3.35) and hemoglobin (10.81±2.1vs. 11.64±1.9) levels was not significant (P>0.05). Vomiting and nausea in the control group was greater than in the control group, but the difference was not significant (P>0.05). We did not detect significant coagulation alterations in the TA group. Conclusion: TA significantly decreased hemorrhage without increasing side effects such as alteration in coagulation parameters, hemodynamic changes, and vomiting and nausea. Use of TA can avoid the need for antihypertensive agents to reduce blood loss in ESS. | ||
| کلیدواژهها | ||
| Endoscopic sinus surgery؛ Hemorrhage؛ Tranexamic acid | ||
| مراجع | ||
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1. Musy PY, Kountakis SE. Anatomic findings in patients undergoing revision endoscopic sinus surgery. Am J Otolaryngol 2004; 25(6):418–22.
2. Chandra RK, Palmer JN, Tangsujarittham T, Kennedy DW. Factors associated with failure of frontal sinusotomy in the early follow-up period. Otolaryngol Head Neck Surg 2004;131(4):514–18.
3. Wormald PJ, Athanasiadis T, Rees G, Robinson S. An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenaline in the control of nasal bleeding during endoscopic sinus surgery. Am J Rhinol 2005;19(3):288–92.
4. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57(6):1005–32.
5. Casati V, Sandrelli L, Speziali G, Calori G, Grasso MA, Spagnolo S. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: a prospective, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 2002; 123(6):1084–91.
6. Wormald PJ. Endoscopic Sinus Surgery: Anatomy, Three-Dimensional Reconstruction, and Surgical Technique. New York: Thieme; 2005: 7-12.
7. Riegle EV, Gunter JB, Lusk RP, Muntz HR, Weiss KL. Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. Laryngoscope 1992;102(7):820–3.
8. Shaw CL, Dymock RB, Cowin A, Wormald PJ. Effect of packing on nasal mucosa of sheep. J Laryngol Otol 2000;114(7):506–9.
9. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion 2008; 48(3):519–25.
10. 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.
11. Yaniv E, Shvero J, Hadar T. Hemostatic effect of tranexamic acid in elective nasal surgery. Am J Rhinol 2006; 20(2):227–9.
12. Senghore N, Harris M. The effect of tranexamic acid (cyclokapron) on blood loss after third molar extraction under a day case general anaesthetic. Br Dent J 1999; 186:634–6.
13. Chhapola S, Matta I. Short-term use of tranexamic acid to reduce blood loss in endoscopic sinus surgery. Clinical Rhinology 2011;4(2):79–81.
14. 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): 611–15.
15. 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):186–89.
16. Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q. The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Article in press. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115(5):595-600. 17. Ker K, Fellow R, Edwards P, Lecture S, Perel P, Shakur H, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054.
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