ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Tranexamic Acid Can Decrease Surgical Blood Loss That Results From Various Orthognathic Surgical Procedures
Clinical Question Can tranexamic acid decrease blood loss during orthognathic surgery?
Clinical Bottom Line Tranexamic acid should be used in all patients undergoing orthognathic surgery that are a high risk for bleeding. It should also be considered for all patients to attempt to decrease their blood loss.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23260768Song/2013183 patients undergoing orthognathic surgery.Systematic Review of Randomized Trials
Key resultsBlood loss due to orthognathic surgery in the 4 RCTs that were reviewed was less in the tranexamic acid group when compared to placebo group (Weighted mean difference (WMD) = -93.56, 95% CI = -132.59=54.52, P < 0.00001).
#2) 22340993Sankar/201250 adolescent orthognathic surgery patients.Randomized Controlled Trial
Key resultsThe mean total blood loss in the tranexamic acid study group was 166.1 ± 65.49 mL and 256.4 ± 77.80 mL in the control group. “The results showed significant reduction in blood loss (p<0.001) and improved quality of the surgical field (p<0.001) in the study group.”
#3) 19070758Choi/200961 patients undergoing bimaxillary osteotomy.Randomized Controlled Trial
Key resultsBlood loss due to the oral and maxillofacial surgical procedures was reduced in the tranexamic acid group. The total blood loss in the tranexamic acid group was (878.6 ± 577.7 mL) statistically less than in the placebo group (1257.2 ± 817.8 mL); P<0.05.
Evidence Search ("tranexamic acid"[MeSH Terms] OR ("tranexamic"[All Fields] AND "acid"[All Fields]) OR "tranexamic acid"[All Fields]) AND ("orthognathic surgery"[MeSH Terms] OR ("orthognathic"[All Fields] AND "surgery"[All Fields]) OR "orthognathic surgery"[All Fields])
Comments on
The Evidence
Two of the articles reviewed were randomized controlled trials while the article by Song et. al., was the only systematic review of randomized controlled trials. They performed a comprehensive, detailed search of relevant trials and assessed the individual studies for validity using clear criteria. Song et. al., performed a meta-analysis. All three articles provided evidence that was applicable to the question and beneficial for developing the clinical bottom line.
Applicability All three articles provided their patient selection criteria and we can be certain that most of the patients in these trials would be representative of an average patient. A benefit of tranexamic acid that might be overlooked is its cost effectiveness. By reducing the surgical blood loss, the hospital may be able to reduce the number of transfusions, thereby saving the patient money and shortening their hospital stay.
Specialty/Discipline (Oral Surgery)
Keywords Tranexamic Acid, Orthognathic Surgery, Blood Loss, Antifibrolytic Agent
ID# 2624
Date of submission: 02/20/2014spacer
E-mail trobough@livemail.uthscsa.edu
Author Kyle Trobough
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis, III, DDS
Faculty mentor/Co-author e-mail ellise3@uthscsa.edu
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