The Efficacy of Tranexamic Acid on the Postoperative Bleeding in Patients Receiving Head-and-Neck Surgery: A Meta-Analysis.

Abstract

We assessed the effect of tranexamic acid on postoperative bleeding, and any adverse effects, in patients undergoing head-and-neck surgery. We searched databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their dates of inception to August 31, 2021. We analyzed studies that compared bleeding-related morbidity between perioperative tranexamic acid and placebo (control) groups. We subanalyzed tranexamic acid administration methods. The extent of postoperative bleeding (standardized mean difference [SMD] = -0.7817, [-1.4237; -0.1398], P = 0.0170, I2 = 92.2%) was significantly less in the treatment group. However, there were no significant between-group differences in terms of operative time (SMD = -0.0463 [-0.2147; 0.1221]; P = 0.5897, I2 = 0.0% [0.0%; 32.9%]); intraoperative blood loss (SMD = -0.7711 [-1.6274; 0.0852], P = 0.0776, I2 = 94.4%); drain removal timing (SMD = -0.3382 [-0.9547; 0.2782], P = 0.2822, I2 = 81.7%); or the amount of infused perioperative fluid (SMD = -0.0622 [-0.2615; 0.1372], P = 0.5410, I2 = 35.5%). Also, there were no significant between-group differences in laboratory findings (serum bilirubin, creatinine, and urea levels; and the coagulation profiles) between the tranexamic acid and control groups. Topical application was associated with a shorter postoperative drain tube dwell time than was systemic administration. Perioperative tranexamic acid significantly reduced postoperative bleeding in patients undergoing head-and-neck surgery. Also, topical administration might be more effective in postoperative bleeding and postoperative drain tube dwell time.