Evidence-based evaluation of the efficacy of tranexamic acid in reducing perioperative blood loss in orthognathic surgery patients

doi:10.19438/j.cjoms.2025.05.013

Abstract

Abstract: PURPOSE: Based on meta-regression and trial sequential analysis, this study aimed to comprehensively evaluate the clinical efficacy with respect to tranexamic acid(TXA) for blood loss control in perioperative patients underwent orthognathic surgery. METHODS: Embase, PubMed, WanFang Data, VIP, China National Knowledge Infrastructure(CNKI), Chinese Clinical Trial Registry(ChiCTR) and Cochrane Central Register of Controlled Trials (CENTRAL) were electronically retrieved to collect clinical studies related to appraise the effectiveness in perioperative orthognathic surgery patients intravenously used TXA from inception to August, 2024. Quality assessment of the risk of bias for randomized controlled trials (RCTs) was performed using Cochrane Collaboration's Risk of Bias Tool (2.0), whereas the Newcastle-Ottawa Scale was used for assessment of the prospective cohort studies. Based on the results of methodological heterogeneity, corresponding meta-analyses were carried out with a random-effects or fixed-effects model applying R programming software. A trial sequential analysis of outcomes was carried out to investigate the reliability and conclusiveness of findings. RESULTS: The paired meta-analysis random-effects model (I²=81%) showed that compared with the control group, the use of TXA significantly reduced the amount of bleeding in perioperative patients [standardized mean difference(SMD) = -1.26; 95%CI (-1.81, -0.71), P<0.01]. Subgroup analysis revealed that TXA had a significant effect on reducing intraoperative bleeding in patients with different surgeries, with monomaxillary orthognathic surgery ranking as the most effective [SMD = -1.58; 95%CI (-2.41, -0.76), P<0.01], followed by bimaxillary orthognathic surgery [SMD = -0.97; 95%CI(-1.69, -0.25), P<0.01]. The result of meta regression showed there was no significant difference in the hemostatic effect of TXA on patients with increasing doses(5, 10, 15, 20 mg/kg) (P>0.05). Sensitivity analysis verified that the pooled values were stable and reliable. Egger's test indicated a certain degree of publication bias(Z=-3.10, P= 0.002). Low risk-of-bias trials showed benefit of tranexamic acid use with a sufficiently powered sample, through trial sequential analysis. CONCLUSIONS: Taken as a whole, existing evidence suggests that TXA can effectively reduce perioperative bleeding in patients undergoing orthognathic surgery, regardless of its dosage administered. However, further clinical researches are still needed to provide more baseline data, transfusion-related indicators, and information on adverse events such as vascular embolism, in order to comprehensively evaluate and analyze the efficacy and safety of a single dose of intravenous TXA for perioperative blood loss control in patients treated with orthognathic surgery.

Key words: Orthognathic surgery, Tranexamic acid, Perioperative blood loss, Evidence-based medicine

CLC Number:

R782.05

Liu Yang, Li Chenxi, Gong Zhongcheng, Ding Mingchao, Sun Jialin. Evidence-based evaluation of the efficacy of tranexamic acid in reducing perioperative blood loss in orthognathic surgery patients[J]. China Journal of Oral and Maxillofacial Surgery, 2025, 23(5): 508-516.

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