Skip to main content

Tranexamic acid in head and neck procedures: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective

We conducted a meta-analysis of all randomized controlled trials (RCTs) that examined the benefits of tranexamic acid (TXA) among cancer patients undergoing head and neck (H&N) procedures.

Methods

We screened five databases from inception until 20 June 2021 and evaluated the risk of bias of the eligible studies. We pooled continuous outcomes using the weighted mean difference (WMD) with 95% confidence interval (CI).

Results

Five studies, comprising seven RCTs, met the inclusion criteria. This meta-analysis included a total of 540 patients; 265 and 275 patients were assigned to the TXA and control group, respectively. Overall, the included RCTs revealed a low risk of bias. The volume of postoperative bleeding was significantly lower in favor of the TXA group compared with the control group (n = 7 RCTs, WMD = − 51.33 ml, 95% CI [− 101.47 to − 1.2], p = 0.04). However, no significant difference was found between both groups regarding the volume of intraoperative bleeding (n = 6 RCTs, WMD = − 3.48 ml, 95% CI [− 17.11 to 10.15], p = 0.62), postoperative hemoglobin (n = 3 RCTs, WMD = 0.42 mg/dl, 95% CI [− 0.27 to 1.11], p = 0.23), duration of drainage tube removal (n = 4 RCTs, MD = − 0.41 days, 95% CI [− 1.14 to 0.32], p = 0.27), and operation time (n = 6 RCTs, WMD = 1.59 min, 95% CI [− 10.09 to 13.27], p = 0.79). TXA was safe and did not culminate in thromboembolic events or major coagulation derangements.

Conclusion

TXA administration is safe and significantly reduces the volume of postoperative bleeding. However, no difference is identified between TXA and control groups regarding the volume of intraoperative bleeding, postoperative hemoglobin level, duration of drainage tube removal, and operation time.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Availability of data and material

All data are available in the article.

References

  1. 1.

    Thakur A, Gupta S, Thakur JS, Minhas RS, Azad RK, Vasanthalakshmi MS et al (2019) Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial. J Laryngol Otol 133:1024–1032

    CAS  Article  Google Scholar 

  2. 2.

    Williams J, Toews D, Prince M (2003) Survey of the use of suction drains in head and neck surgery and analysis of their biomechanical properties. J Otolaryngol 32:16–22

    Article  Google Scholar 

  3. 3.

    Byers RM, Ballantyne AJ, Goepfert H, Guillamondegui OM, Larson DL, Medina J (1982) Clinical effects of closed suction drainage on wound healing in patients with head and neck cancer. Arch Otolaryngol 108:723–726

    CAS  Article  Google Scholar 

  4. 4.

    Harris T, Doolarkhan Z, Fagan JJ (2011) Timing of removal of neck drains following head and neck surgery. Ear Nose Throat J 90:186–189

    Article  Google Scholar 

  5. 5.

    Amir I, Morar P, Belloso A (2010) Postoperative drainage in head and neck surgery. Ann R Coll Surg Engl 92:651–654

    Article  Google Scholar 

  6. 6.

    Pereira BM, Bortoto JB, Fraga GP (2018) Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir 45:e1900

    Article  Google Scholar 

  7. 7.

    Fraser IS, Porte RJ, Kouides PA, Lukes AS (2008) A benefit-risk review of systemic haemostatic agents: part 1: in major surgery. Drug Saf 31:217–230

    CAS  Article  Google Scholar 

  8. 8.

    Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032

    CAS  Article  Google Scholar 

  9. 9.

    Wong J, George RB, Hanley CM, Saliba C, Yee DA, Jerath A (2021) Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery. Can J Anaesth 68:894–917

    CAS  Article  Google Scholar 

  10. 10.

    Chen CC, Wang CC, Wang CP, Lin TH, Lin WD, Liu SA (2008) Prospective, randomized, controlled trial of tranexamic acid in patients who undergo head and neck procedures. Otolaryngol Head Neck Surg 138:762–767

    Article  Google Scholar 

  11. 11.

    Kulkarni AP, Chaukar DA, Patil VP, Metgudmath RB, Hawaldar RW, Divatia JV (2016) Does tranexamic acid reduce blood loss during head and neck cancer surgery? Indian J Anaesth 60:19–24

    CAS  Article  Google Scholar 

  12. 12.

    Auvinen O, Baer GA, Nordback I, Saaristo J (1987) Antifibrinolytic therapy for prevention of hemorrhage during surgery of the thyroid gland. Klin Wochenschr 65:253–255

    CAS  Article  Google Scholar 

  13. 13.

    Anand S, Singh V, Sahu PK (2020) Evaluating the role of topical tranexamic acid in cancers of the head-and-neck: a single-center randomized controlled trial. Cancer Res Stat Treat 3:461

    Google Scholar 

  14. 14.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  Google Scholar 

  15. 15.

    Higgins J GS (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Internet]. [Updated March 2011]. The Cochrane Collaboration, www.handbook.cochrane.org.AAf

  16. 16.

    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  17. 17.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  18. 18.

    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    CAS  Article  Google Scholar 

  19. 19.

    Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  20. 20.

    Riaz O, Aqil A, Asmar S, Vanker R, Hahnel J, Brew C et al (2019) Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study. J Orthop Traumatol 20:28

    Article  Google Scholar 

  21. 21.

    Churchill JL, Puca KE, Meyer ES, Carleton MC, Truchan SL, Anderson MJ (2016) Comparison of ε-aminocaproic acid and tranexamic acid in reducing postoperative transfusions in total hip arthroplasty. J Arthroplasty 31:2795–9.e1

    Article  Google Scholar 

  22. 22.

    Xu Y, Sun S, Feng Q, Zhang G, Dong B, Wang X et al (2019) The efficiency and safety of oral tranexamic acid in total hip arthroplasty: a meta-analysis. Medicine 98:e1796

    Google Scholar 

  23. 23.

    Ma QM, Han GS, Li BW, Li XJ, Jiang T (2020) Effectiveness and safety of the use of antifibrinolytic agents in total-knee arthroplasty: a meta-analysis. Medicine 99:e20214

    Article  Google Scholar 

  24. 24.

    Donovan RL, Varma JR, Whitehouse MR, Blom AW, Kunutsor SK (2021) Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: a systematic review and meta-analysis. J Orthop 24:239–247

    Article  Google Scholar 

  25. 25.

    Koh A, Adiamah A, Gomez D, Sanyal S (2021) Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis. BJS Open. https://doi.org/10.1093/bjsopen/zrab004

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Chan CC, Chan YY, Tanweer F (2013) Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol 270:735–748

    Article  Google Scholar 

  27. 27.

    Kim DH, Kim S, Kang H, Jin HJ, Hwang SH (2019) Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: a meta-analysis and systematic review. Laryngoscope 129:800–807

    Article  Google Scholar 

  28. 28.

    Stortroen NE, Tubog TD, Shaffer SK (2020) Prophylactic tranexamic acid in high-risk patients undergoing cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. AANA J 88:273–281

    PubMed  Google Scholar 

  29. 29.

    Hu M, Liu ZB, Bi G (2019) Efficacy and safety of tranexamic acid in orthopaedic trauma surgery: a meta-analysis. Eur Rev Med Pharmacol Sci 23:11025–11031

    CAS  PubMed  Google Scholar 

  30. 30.

    Benoni G, Lethagen S, Nilsson P, Fredin H (2000) Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthop Scand 71:250–254

    CAS  Article  Google Scholar 

  31. 31.

    Chen X, Zheng F, Zheng Z, Wu X, Wu C (2019) Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty: a systematic review and meta-analysis. Medicine 98:e15248

    CAS  Article  Google Scholar 

  32. 32.

    Durai R, Mownah A, Ng PC (2009) Use of drains in surgery: a review. J Perioper Pract 19:180–186

    Article  Google Scholar 

  33. 33.

    Houston BL, Uminski K, Mutter T, Rimmer E, Houston DS, Menard CE et al (2020) Efficacy and safety of tranexamic acid in major non-cardiac surgeries at high risk for transfusion: a systematic review and meta-analysis. Transfus Med Rev 34:51–62

    Article  Google Scholar 

Download references

Funding

None.

Author information

Affiliations

Authors

Contributions

HMA and AA contributed to study supervision, study design, study conception, data analysis, literature review, and manuscript writing. SS, KAP, MAA, MA, SFA, and KHA DM contributed to literature review, data collection, and manuscript revision. All authors revised manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript and agreed to be held responsible for data integrity.

Corresponding author

Correspondence to Hemail M. Alsubaie.

Ethics declarations

Conflict of interest

None.

Ethical approval

Not applicable as this investigation does not involve direct contact with humans or animals.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

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

Meetings at which the manuscript was presented: none.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 303 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alsubaie, H.M., Abu-Zaid, A., Sayed, S.I. et al. Tranexamic acid in head and neck procedures: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol (2021). https://doi.org/10.1007/s00405-021-07132-6

Download citation

Keywords

  • Tranexamic acid
  • Bleeding
  • Blood transfusion
  • Head and neck
  • Meta-analysis