Oral and maxillofacial surgery
The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials

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Objective

The objective of this article was to evaluate the efficacy of tranexamic acid on blood loss in orthognathic surgery. A meta-analysis was performed.

Study Design

The PubMed and EMBASE electronic databases were searched until June 30, 2012. Eligible studies were restricted to randomized controlled trials (RCTs).

Results

Four RCTs with 183 patients were included. The results showed that intraoperative blood loss in the tranexamic acid group was statistically reduced (weighted mean difference [WMD] = −93.56, 95% CI = −132.59-54.52, P < .00001). However, the postoperative levels of hemoglobin (Hb) and hematocrit (Hct) have no significant difference compared with placebo groups (WMD = 0.50, 95% CIs = −0.43-1.43, P = .29 and WMD = 0.18, 95% CIs = −1.64-1.99, P = .85, respectively).

Conclusions

This meta-analysis confirms that tranexamic acid can effectively reduce intraoperative blood loss in orthognathic surgery, especially by intravenous administration. But, tranexamic acid cannot affect postoperative levels of Hb and Hct.

Section snippets

Search strategy

A search was conducted of 2 electronic databases: PubMed and EMBASE (the last date was updated on June 30, 2012). The following search terms were used: tranexamic acid, hemodynamics, osteotomy, oral surgery, orthognathic surgery, orthognathic surgical procedures, antifibrinolytic agents. The search was done on studies conducted on human subjects, restricted to the English language. The reference lists of reviews and retrieved articles were handsearched at the same time. We did not consider

Study characteristics

There were 2194 articles relevant to the searching words (Fig. 1). Through the step of filtering the title, 834 of these articles were excluded (294 reviews, 540 nonabstracts). RCTs from 262 articles were reviewed and an additional 1428 articles were excluded (1048 non-RCTs, 380 nonhuman studies). Of these, 258 were excluded (125 were nonplacebo controls, 6 duplicates, and 127 nonorthognathic surgeries); thus, 4 articles,27, 28, 29, 30 which included 183 cases, were found to conform to our

Discussion

Orthognathic surgeries, especially those involved in maxillary interventions, such as Le Fort I osteotomies, are known to occasionally result in significant loss of blood. Yu and colleagues31 reported that 72.4% of orthognathic patients require bimaxillary surgery, and the volume of blood loss in Le Fort I osteotomies is about 50% of multiple segmentalized osteotomies. In addition, about 30% of patients undergoing bimaxillary osteotomies have need of a blood transfusion.2, 32 Various approaches

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