Impact of Intravenous Tranexamic Acid on Intraoperative Bleeding during Endoscopic Sinus Surgery

Main Article Content

Pawan Kumar Padhy
Ramakrishnan Narayanaswamy

Abstract

Introduction


Bleeding during surgery is one of the most important concerns in endoscopic sinus surgery (ESS). The study conducted was aimed at assessing the efficacy of tranexamic acid on bleeding during endoscopic sinus surgeries. 


Materials and Methods


A total of 30 patients were enrolled for the study. Lund and Mackay symptom score and radiological staging was used to compare clinical profile. The surgical field was assessed by the surgeon who was blinded, i.e., was not aware of which set of patients were receiving the drug. Boezaart and van de Merwe grading scale was used to assess the intraoperative surgical field. Both groups were selected so as to comprise of patients having similar clinical profile in terms of symptom score and radiological staging. 


Results


In the arm receiving tranexamic acid, blood loss was found to be less and statistically significant (p=0.0157). The surgical field in endoscopic sinus surgery is more important factor in determining the completion and satisfactory outcomes of the surgery. Significantly high percentage (80%) of patients who were given the drug had a grade 2 scale when compared to (26.7%) in patients not receiving the drug. The difference in score in surgical field grading scale was also statistically significant (p=0.0034). The reported side effects of tranexamic acid mainly include nausea, vomiting, and possibly arterial or venous thrombosis, however none of the patients in our study had any side effects of the drug. Post-operative stay in the hospital was uneventful. 


Conclusion


Intravenous Tranexamic acid reduced the intraoperative bleeding significantly and was useful in providing a better operative field.

Article Details

How to Cite
1.
Padhy PK, Narayanaswamy R. Impact of Intravenous Tranexamic Acid on Intraoperative Bleeding during Endoscopic Sinus Surgery. BJOHNS [Internet]. 2019Dec.29 [cited 2024May18];27(3):198-203. Available from: https://bjohns.in/journal3/index.php/bjohns/article/view/8
Section
Main article
Author Biographies

Pawan Kumar Padhy, Military Hospital, Agra

ENT Specialist

Ramakrishnan Narayanaswamy, Command Hospital(CC) Lucknow Cantt PIN 226002

Professor, Dept of ENT

References

Wormald PJ. The surgical field in endoscopic sinus surgery. In: Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction and Surgical Technique. Thieme, New York 2005, 112, 7-12

Damm M, Quante G, Jungehuelsing M, Stennert E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002; 112: 310-5

Pavlin JD, Colley PS, Weymuller Jr, van Norman GV, Gunn HC, Koerschgen ME. Propofol versus isoflurane for endoscopic sinus surgery. Am J Otolaryngol. 1999; 20:96-101

Jacobi KE, Bohm BE, Rickauer AJ, Jacobi C, Hemmerling TM. Moderate controlled hypotension with sodi- um nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. Clin Anesth. 2000; 12:202-7

Simpson P. Perioperative blood loss and its reduction: the role of the anaesthetist. Br J Anaesth. 1992; 69:498–507

Sivarajan M, Amory DW, Everett GB, Buffington C. Blood pressure, not cardiac output, determines blood loss during induced hypotension. Anesth Analg. 1980; 59:203-6

Reigle EV, Gunter JB, Lusk RP, Muntz HR, Weiss KL. Comparison of vasoconstrictors for functional endoscopic sinus surgery in children. Laryngoscope 1992: 102:820-3

Wormald PJ, Athanasiadis T, Rees G, Robinson S. An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery. Am J Rhinol. 2005; 19:288-92

Maune S, Jeckström W, Thomsen H, Rudert H. Indication, incidence and management of blood transfusion during sinus surgery: a review over 12 years. Rhinology 1997: 35:2-5

Yaniv E, Shvero J, Hadar T. Hemostatic effect of tranexamic acid in elective nasal surgery. Am J Rhinol. 2006; 20:227-9

Stankiewicz JA. Complications in endoscopic intranasal ethmoidectomy: an update. Laryngoscope 1989; 99:686-90

Casati V, Sandrelli L, Speziali G et al. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg. 2002; 123:1084-91

Manucci PM. Drug therapy: Hemostatic drugs. N Engl J Med. 1998; 339:245-53

Dunn C, Goa K. Tranexamic acid – A review of its use in surgery and other indications. Drugs 1999; 57:1005-32

Athanasiadis T, Beule A, Embate J, Steinmeier E, Field J, Wormald PJ. Standardized video‐endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi‐centre study. Laryngoscope 2008;118(2):314-9

Chhapola S, Matta I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. An International Journal Clinical Rhinology 2011; 4(2):79-81

Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. Journal of clinical anesthesia 2011; 23(8):611-5

Sahar M, Hasanein R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egyptian Journal of Anaesthesia 2015; 31(1):1-7

Langille MA, Chiarella A, Côté DW, Mulholland G, Sowerby LJ, Dziegielewski PT, Wright ED. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double‐blind randomized controlled trial. Int Forum Allergy Rhinol. 2013; 3(4):315-8. doi: 10.1002/alr.21100

Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol. 2007;21(6):737-42

Jahanshahi J, Hashemian F, Pazira S, Bakhshaei MH, Farahani F, Abasi R, Poorolajal J. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One 2014; 9(8):e104477. doi: 10.1371/journal.pone.0104477.