Skip to main content
SpringerLink
Log in

Tranexamic Acid and Rhinoplasty: How Do Different Administration Routes Affect Effectiveness?

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

Abstract

Background

The aim of this study was to evaluate the effectiveness of the intravenous, oral and local application of tranexamic acid in operation time, intraoperative bleeding, postoperative edema and ecchymosis in rhinoplasty.

Methods

This was a randomized, double-blinded, prospective study. We included 146 patients who underwent rhinoplasty at the Bezmialem Vakif University Medical Faculty Otorhinolaryngology Clinic between April 2021 and April 2022. The patients were divided into four groups: Group 1 (intravenous TXA), Group 2 (oral TXA), Group 3 (topical TXA), and Group 4 (control). Operation time was recorded. Bleeding volume was measured in the suction chamber and nasopharyngeal pack. Postoperative edema and ecchymosis were evaluated using a scale at the end of the operation, on the 1st, 3rd, and 7th days.

Results

There was no statistically significant difference between groups in terms of mean operation time (p = 0.894). There was a statistically significant lower mean intraoperative bleeding level in Group 2 from the other groups (p = 0.020). Group 3 had significantly lower scores for postoperative edema than the other groups at the end of the operation, on the 1st, 3rd, and 7th days (p < 0.05), and significantly lower scores for postoperative ecchymosis at the end of the operation (p = 0.013) and on the 3rd day (p = 0.024). Although group 3 had a lower score than the other groups in the ecchymosis measurements on the 1st, and 7th days, no statistically significant results were obtained.

Conclusions

Local application of tranexamic acid is founded more beneficial for reducing postoperative edema and ecchymosis in rhinoplasty than intravenous and/or oral applications in this study.

Level of Evidence I

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. Heilbronn C, Cragun D, Wong BJ (2020) Complications in rhinoplasty: a literature review and comparison with a survey of consent forms. Fac Plast Surg Aesthet Med 22(1):50–56

    Article  Google Scholar 

  2. Nilsson IM (1980) Clinical pharmacology of aminocaproic and tranexamic acids. J Clin Pathol Suppl (R Coll Pathol) 14:41

    Article  CAS  PubMed  Google Scholar 

  3. Fu DJ, Chen C, Guo L, Yang L (2013) Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Chin J Traumatol 16(02):67–76

    PubMed  Google Scholar 

  4. Zhang F, Wang K, Li FN, Huang X, Li Q, Chen Z, Song QX (2014) Effectiveness of tranexamic acid in reducing blood loss in spinal surgery: a meta-analysis. BMC Musculoskelet Disord 15(1):1–9

    Article  Google Scholar 

  5. 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 

  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. JAMA Fac Plast Surg. https://doi.org/10.1001/jamafacial.2018.1737

    Article  Google Scholar 

  7. Ipek HD, Bezgin SÜ, Çakabay T, Çelebi S (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 

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

    Article  Google Scholar 

  9. Hoffmann DF, Cook TA, Quatela VC, Wang TD, Brownrigg PJ, Brummett RE (1991) Steroids and rhinoplasty: a double-blind study. Arch Otolaryngol Head Neck Surg 117(9):990–993

    Article  CAS  PubMed  Google Scholar 

  10. Sowerby L, Kim LM, Chow W, Moore C (2019) Intra-operative nasal compression after lateral osteotomy to minimize post-operative Peri-orbital ecchymosis and edema. J Otolaryngol Head Neck Surg 48(1):1–5

    Article  Google Scholar 

  11. Levin M, Ziai H, Roskies M (2022) Modalities of post-rhinoplasty edema and ecchymosis measurement: a systematic review. Plast Surg 30(2):164–174

    Article  Google Scholar 

  12. de Vasconcellos SJDA, do Nascimento-Júnior EM, de Aguiar Menezes MV, Mendes MLT, 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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  Google Scholar 

  14. Gun R, Yorgancilar E, Yildirim M, Bakir 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. Kosucu M, Ömür S, Besir A, Uraloglu M, Topbas M, Livaoglu 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 

  16. 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 Cranio-Maxillofac Surg 41(2):124–128

    Article  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. 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 

  19. Wu B, Chen S, Sun K, Xu X (2021) Complications associated with rhinoplasty: an umbrella review of meta-analyses. Aesthet Plast Surg 46:1–13

    CAS  Google Scholar 

  20. Mannucci PM (1998) Hemostatic drugs. N Engl J Med 339(4):245–253

    Article  CAS  PubMed  Google Scholar 

  21. Zhang LK, Ma JX, Kuang MJ, Zhao J, Wang Y, Lu B, Ma XL (2017) Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: a systematic review and meta-analysis. Int J Surg 45:77–84

    Article  PubMed  Google Scholar 

  22. Pilbrant Å, Schannong M, Vessman J (1981) Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 20(1):65–72

    Article  CAS  PubMed  Google Scholar 

  23. Wei Z, Liu M (2015) The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2720 cases. Transfus Med 25(3):151–162

    Article  CAS  PubMed  Google Scholar 

  24. Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, Memtsoudis SG (2014) Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ. https://doi.org/10.1136/bmj.g4829

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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 

  26. Van Der Staak FHJ, De Haan AFJ, Geven WB, Festen C (1997) Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg 32(4):594–599

    Article  PubMed  Google Scholar 

  27. Ker K, Edwards P, Perel P, Shakur H, Roberts I (2012) Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 344:e3054

    Article  PubMed  PubMed Central  Google Scholar 

  28. Laoruengthana A, Rattanaprichavej P, Chaibhuddanugul N, Varakornpipat P, Galassi M, Pongpirul K (2019) Blood loss reduction: effect of different knee prosthesis designs and use of tranexamic acid—a randomized controlled trial. Eur J Orthop Surg Traumatol 29(7):1519–1524

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  30. 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. Aesthet Plast Surg 46(3):1314–1320

    Article  Google Scholar 

  31. 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 

  32. Hazrati E, 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

Acknowledgements

The authors declare that they have no conflict of interest.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Samsun Education and Research Hospital, 55090, İlkadim, Samsun, Turkey

    Seda Sezen Göktaş

  2. Department of Otorhinolaryngology, Bezmialem Vakif University Medical Faculty, Fatih, Istanbul, Turkey

    Alper Yenigün, Ahmet Onur Sütcü, Orhan Özturan & Selahattin Tuğrul

Authors
  1. Seda Sezen Göktaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alper Yenigün
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmet Onur Sütcü
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Orhan Özturan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selahattin Tuğrul
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seda Sezen Göktaş.

Ethics declarations

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1954 Helsinki Declaration and its later amendments or comparable ethical standards.

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

Sezen Göktaş, S., Yenigün, A., Sütcü, A.O. et al. Tranexamic Acid and Rhinoplasty: How Do Different Administration Routes Affect Effectiveness?. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03951-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00266-024-03951-0

Keywords

Search

Navigation