A Decade of Tranexamic Acid (TXA) in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials (RCTs)
Methods/Technique: A systematic review and meta-analysis were conducted following the PRISMA guidelines. An established appraisal process (Grading of Recommendations Assessment, Development, and Evaluation methodology or GRADE) was used to rate the level of evidence and provide evidence-based clinical recommendations. Clinical recommendations were based on prospective studies only.
Results/Complications: Twelve randomized controlled trials (2015-2024) describing the use of intravenous (IV) or oral TXA in rhinoplasty were included comprising a total of 882 patients. Intravenous administration of TXA was significantly associated with reduced blood loss in rhinoplasty with a mean difference of −16.85 ml (95% CI, −20.41 to −15.34, p < 0.00001 [high-certainty evidence]). Oral administration was significantly associated with reduced blood loss with a mean difference −61.70 (95% CI, −83.02 to −40.39, p < 0.00001 [moderate certainty evidence]). No TXA-related complications including thrombotic events, allergic reactions or anaphylaxis events were reported (0%).
Conclusion: This is the largest study to date on the use of TXA rhinoplasty, summarizing a decade of prospective experience. There is high-certainty evidence to support the promising role of IV TXA in blood loss reduction in rhinoplasty procedures. Further studies with standardized outcome measures are needed to quantify the effect of TXA administration on postoperative edema and ecchymoses in rhinoplasty.