Intraoperative bleeding during FESS can reduce visibility and obscure important landmarks. This can result in longer operative times, increase risks of complications and even lead to incomplete surgery. Tranexamic acid is a drug which prevents fibrinolysis and stabilises blood clots. It can therefore be administered to decrease intraoperative bleeding. Potential side-effects include nausea and vomiting and hypotension. Concerns also remain about the potential to precipitate thromboembolic events. In this meta-analysis, they sought to assess whether preoperative tranexamic acid reduces intraoperative bleeding rates and whether it is well-tolerated. Of 27 potential studies, seven comprising 562 participants met the strict inclusion criteria and were included for meta-analysis. All seven studies compared perioperative tranexamic acid administration (treatment group) with a placebo. Operative time and intraoperative blood loss were statistically lower in the treatment group than placebo group. In addition, the quality of the surgical field and surgeon satisfaction were statistically higher in the treatment group than the placebo group. As for unwanted effects of the tranexamic acid, there were no significant differences in the hemodynamic and coagulation profiles of the two groups and, encouragingly, tranexamic acid had no significant effect on emetic or thrombotic events compared to placebo. This study provides level 1A evidence that tranexamic acid reduces intraoperative bleeding during functional endoscopic sinus surgery and is well-tolerated. It has the potential to decrease operative time and blood loss intraoperatively, increasing the satisfaction of surgeons.

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review.
Kim DH, Kim S, Kang H, et al.
2018 Dec doi: 10.1002/lary.27766.
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Sarj Vasani

Royal Brisbane Hospital, Brisbane Australia.

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