Skip to main content
SpringerLink
Log in

Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial

  • Original Article
  • Rhinoplasty
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background and Aims

The purpose of this study was assessing the effect of local injection of tranexamic acid (TXA) on the amount of bleeding during the primary rhinoplasty and edema and ecchymosis following the surgery.

Methods

In this randomized clinical trial, 50 patients applying for primary rhinoplasty were divided into two groups of intervention and observation. In the intervention group, 10 mg/kg of TXA was injected locally to the operation field. In the observation group, no medicine was injected. The same anesthesia technique was used during the operation for all the patients. Age, sex, blood pressure, bleeding amount during the operation, the amount of edema and ecchymosis on the first and seventh day after the surgery were noted. The data were analyzed by the SPSS software version 24 and using descriptive statistics of frequency and percentage of frequency and Fisher and Mann–Whitney’s exact statistical tests.

Results

Our results showed that there was a significant difference between the amounts of bleeding during the surgery between two groups (P-value < 0.001). Also, the postoperative edema on the first and seventh day in intervention group was less than the observation group (P-value < 0.001). There were no complications during the surgery and in the follow-up of the patients.

Conclusion

We revealed that local injection of TXA during the rhinoplasty procedure and decreased the intraoperative bleeding and postoperative ecchymosis and edema without any side effects and complications.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Angelos PC, Been MJ, Toriumi DM (2012) Contemporary review of rhinoplasty. Arch Facial Plast Surg 14(4):238–247

    Article  PubMed  Google Scholar 

  2. Lee MR, Unger JG, Rohrich RJ (2011) Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications. Plast Reconstr Surg 128(5):538e–550e

    Article  PubMed  Google Scholar 

  3. Rhee JS, Arganbright JM, McMullin BT, Hannley M (2008) Evidence supporting functional rhinoplasty or nasal valve repair: a 25-year systematic review. Otolaryngol Head Neck Surg 139(1):10–20

    Article  PubMed  Google Scholar 

  4. Cochran CS, Landecker A (2008) Prevention and management of rhinoplasty complications. Plast Reconstr Surg 122(2):60e-e67

    Article  PubMed  Google Scholar 

  5. Rettinger G (2007) Risks and complications in rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 6:Doc08

  6. McGuire C, Nurmsoo S, Samargandi OA, Bezuhly M (2019) Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: a systematic review and meta-analysis. JAMA Facial Plast Surg. 21(3):191–198

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT (2006) Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty. Aesthetic Plast Surg 30(2):150–154

    Article  PubMed  Google Scholar 

  8. Hatef DA, Ellsworth WA, Allen JN, Bullocks JM, Hollier LH Jr, Stal S (2011) Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta-analysis. Aesthet Surg J 31(6):648–657

    Article  PubMed  Google Scholar 

  9. Gutierrez S, Wuesthoff C (2014) Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg (Oakv). 22(2):83–87

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ragab SM, Hassanin MZ (2010) Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach. Otolaryngol Head Neck Surg 142(1):48–54

    Article  PubMed  Google Scholar 

  11. Ping WD, Zhao QM, Sun HF, Lu HS, Li F (2019) Role of tranexamic acid in nasal surgery: a systemic review and meta-analysis of randomized control trial. Medicine (Baltimore) 98(16):e15202

    Article  CAS  PubMed  Google Scholar 

  12. Ong AA, Farhood Z, Kyle AR, Patel KG (2016) Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 137(5):1448–1462

    Article  CAS  PubMed  Google Scholar 

  13. Rahimzadeh P, Faiz SH, Alebouyeh MR (2012) Effects of premedication with metoprolol on bleeding and induced hypotension in nasal surgery. Anesth Pain Med 1(3):157–161

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gun R, Yorgancılar E, Yıldırım M, Bakır S, Topcu I, Akkus Z (2011) Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty. Int J Oral Maxillofac Surg 40(7):722–729

    Article  CAS  PubMed  Google Scholar 

  15. Tuncel U, Turan A, Bayraktar MA, Erkorkmaz U, Kostakoglu N (2013) Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty. J Craniomaxillofac Surg 41(2):124–128

    Article  PubMed  Google Scholar 

  16. Koşucu M, Omür S, Beşir A, Uraloğlu M, Topbaş M, Livaoğlu M (2014) Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty. J Craniofac Surg 25(2):471–475

    Article  PubMed  Google Scholar 

  17. Gruber RP, Zeidler KR, Berkowitz RL (2015) Desmopressin as a hemostatic agent to provide a dry intraoperative field in rhinoplasty. Plast Reconstr Surg 135(5):1337–1340

    Article  CAS  PubMed  Google Scholar 

  18. Ockerman A, Vanassche T, Garip M, Vandenbriele C, Engelen MM, Martens J et al (2021) Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review. Thromb J 19(1):54

    Article  PubMed  PubMed Central  Google Scholar 

  19. Karimi A, Mohammadi SS, Hasheminasab M (2012) Efficacy of tranexamic acid on blood loss during bimaxilary osteotomy: a randomized double blind clinical trial. Saudi J Anaesth 6(1):41–45

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lemay E, Guay J, Côté C, Roy A (2004) Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anaesth 51(1):31–37

    Article  PubMed  Google Scholar 

  21. Later AF, Maas JJ, Engbers FH, Versteegh MI, Bruggemans EF, Dion RA et al (2009) Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardiothorac Surg 36(2):322–329

    Article  PubMed  Google Scholar 

  22. Ren Z, Li S, Sheng L, Zhuang Q, Li Z, Xu D et al (2017) Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study. Medicine (Baltimore) 96(42):e8233

    Article  CAS  PubMed  Google Scholar 

  23. Lošťák J, Gallo J, Večeřa M, Špička J, Langová K (2017) Local Application of tranexamic acid in total hip arthroplasty decreases blood loss and consumption of blood transfusion. Acta Chir Orthop Traumatol Cech 84(4):254–262

    Article  PubMed  Google Scholar 

  24. Zabeeda D, Medalion B, Sverdlov M, Ezra S, Schachner A, Ezri T et al (2002) Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization. Ann Thorac Surg 74(3):733–738

    Article  PubMed  Google Scholar 

  25. Ekbäck G, Axelsson K, Ryttberg L, Edlund B, Kjellberg J, Weckström J et al (2000) Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg 91(5):1124–1130

    Article  PubMed  Google Scholar 

  26. Boezaart AP, van der Merwe J, Coetzee A (1995) Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 42(5 Pt 1):373–376

    Article  CAS  PubMed  Google Scholar 

  27. Locketz GD, Lozada KN, Bloom JD (2020) Tranexamic acid in aesthetic facial plastic surgery: a systematic review of evidence, applications, and outcomes. Aesthet Surg J Open Forum 2(3):ojaa029

    Article  PubMed  PubMed Central  Google Scholar 

  28. Butz DR, Geldner PD (2016) The use of tranexamic acid in rhytidectomy patients. Plast Reconstr Surg-Global Open. 4(5):e716

    Article  Google Scholar 

  29. Schroeder RJ, Langsdon PR (2020) Effect of local tranexamic acid on hemostasis in rhytidectomy. Facial Plast Surg Aesthet Med 22(3):195–199

    Article  PubMed  Google Scholar 

  30. Sagiv O, Rosenfeld E, Kalderon E, Barazani TB, Zloto O, Martinowitz U et al (2018) Subcutaneous tranexamic acid in upper eyelid blepharoplasty: a prospective randomized pilot study. Can J Ophthalmol 53(6):600–604

    Article  PubMed  Google Scholar 

  31. Avci H (2021) The effect of different dose regimens of tranexamic acid in reducing blood loss in rhinoplasty: a prospective randomized controlled study. J Craniofac Surg 32(5):e442–e444

    Article  PubMed  Google Scholar 

  32. Eftekharian HR, Rajabzadeh Z (2016) The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty. J Craniofac Surg 27(1):97–100

    Article  PubMed  Google Scholar 

  33. Ghavimi MA, Taheri Talesh K, Ghoreishizadeh A, Chavoshzadeh MA, Zarandi A (2017) Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double-blind study. J Craniomaxillofac Surg 45(6):897–902

    Article  PubMed  Google Scholar 

  34. Sakallioğlu Ö, Polat C, Soylu E, Düzer S, Orhan İ, Akyiğit A (2015) The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 74(4):392–396

    Article  PubMed  Google Scholar 

  35. Mehdizadeh M, Ghassemi A, Khakzad M, Mir M, Nekoohesh L, Moghadamnia A et al (2018) Comparison of the effect of dexamethasone and tranexamic acid, separately or in combination on post-rhinoplasty edema and ecchymosis. Aesthetic Plast Surg 42(1):246–252

    Article  PubMed  Google Scholar 

  36. Afzali SL, Panahi H, Ganji F, Ziaei S, Sedaghat N (2022) Re-evaluating the effect of preoperative tranexamic acid on blood loss and field quality during rhinoplasty: a randomized double-blinded controlled trial. Aesthetic Plast Surg 46(3):1314–1320

    Article  PubMed  Google Scholar 

  37. Cristel RT, Demesh D, Patel MJ, Shah AR (2022) Quantitative analysis of tranexamic acid effects on ecchymosis in rhinoplasty. Facial Plast Surg Aesthet Med. 24(3):228–232

    Article  PubMed  Google Scholar 

  38. de Vasconcellos SJA, do Nascimento-Júnior EM, de Aguiar Menezes MV, Tavares Mendes ML, de Souza Dantas R, Martins-Filho PRS (2018) Preoperative tranexamic acid for treatment of bleeding, edema, and ecchymosis in patients undergoing rhinoplasty: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 144(9):816-823

  39. Meaidi A, Mørch L, Torp-Pedersen C, Lidegaard O (2021) Oral tranexamic acid and thrombosis risk in women. EClinicalMedicine. 35:100882

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ross J, Al-Shahi SR (2012) The frequency of thrombotic events among adults given antifibrinolytic drugs for spontaneous bleeding: systematic review and meta-analysis of observational studies and randomized trials. Curr Drug Saf 7(1):44–54

    Article  CAS  PubMed  Google Scholar 

  41. İpek HD, Bezgin S, Çakabay T, Çelebi Ş (2021) The effects of intraoperative local tranexamic acid on periorbital edema and ecchymosis in septorhinoplasty. J Craniofac Surg 32(6):e526–e530

    Article  PubMed  Google Scholar 

  42. Hazrati E, Haki BK, Masnour-Ghanaei A, Soleimanlo A, Rafiei M (2021) Evaluation of local tranexamic acid on septoplastic surgery quality. J Plast Reconstr Aesthet Surg 74(10):2744–2750

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, 21th Alley, Seyed Jamaloddin Asad Abadi St, Tehran, Iran

    Reza Vaghardoost, Aidin Ahmadi Dahaj, Tayyeb Ghadimi, Siamak Farokh Forghani & Soheila Naderi Gharahgheshlagh

  2. Burn Research Center, Iran University of Medical Sciences, Tehran, Iran

    Reza Vaghardoost, Aidin Ahmadi Dahaj, Mona Haji Mohammad, Tayyeb Ghadimi, Siamak Farokh Forghani & Soheila Naderi Gharahgheshlagh

Authors
  1. Reza Vaghardoost
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aidin Ahmadi Dahaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mona Haji Mohammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tayyeb Ghadimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siamak Farokh Forghani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Soheila Naderi Gharahgheshlagh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aidin Ahmadi Dahaj.

Ethics declarations

Conflict of interest

The author declares that he has no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Iran University of Medical Sciences research committee (No.IR.IUMS.FMD.REC.1401.254).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Rights and Permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vaghardoost, R., Ahmadi Dahaj, A., Haji Mohammad, M. et al. Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial. Aesth Plast Surg 48, 702–708 (2024). https://doi.org/10.1007/s00266-023-03441-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03441-9

Keywords

Search

Navigation