Evaluation of intravenous tranexamic acid on bleeding during functional endoscopic sinus surgery

Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anesthesiologists despite several modalities available for improving the surgical field. In spite of demonstrated favorable effects of Tranexamic acid (TA) on bleeding tendency in cardiac, major orthopedic, transplantation and prostate surgeries, Its IV use in FESS has never been examined. This study was conducted to evaluate the efficacy of intravenous TA in improving the surgical field in FESS.

In placebo-controlled clinical trial a total of 88 ASA physical status I-II patients, aged 15-66 years, undergoing endoscopic sinus surgery under general anesthesia were allocated based randomly table number, to receive either intravenous TA 15mg/kg or sterile water 200 cc as a bolus dose immediately before induction of anesthesia. Anesthesia and surgery protocols were the same in both groups. Bleeding and satisfaction scores were obtained from the surgeon and his aid and compared between two groups.

In view of the surgeon, the median (range) bleeding scores in the TA group was 98.41 (51.35) and in placebo group was 148.98 (71.75) (pvalue= 0.01). Accordingly the surgeon was more satisfied with the surgical field in the TA group than placebo group.

Intravenous TA can not clinically reduce bleeding during FESS.