The value of tranexamic acid in orthognathic surgery

Abstract

Orthognathic Surgery is a common procedure for the correction of dentofacial deformity. It may be associated with significant blood loss especially in bimaxillary osteotomies with segmentalization. Different haemostatic measures have been advocated including the use of hypotensive anaesthesia and haemostastic agents such as aprotinin, desmopressin, Yunnan baiyao. Tranexamic acid (TA) is a lysine analogue which acts as a clot stabilizer. It has been marketed for decades and it is an affordable drug. Several clinical trials were carried out in the last decade and showed preoperative intravenous bolus of TA could significantly reduce blood loss in orthognathic surgery. Two studies even tried to use TA topically during bimaxillary osteotomy. We performed a randomized controlled trial with 61 patients from 2005 to 2008 and demonstrated a 30% reduction of mean blood loss in patients receiving a single preoperative bolus of TA with standard hypotensive anaesthesia during bimaxillary osteotomy. No adverse event or complication related to the use of TA was found. Although it appeared that TA was cost effective in reducing blood loss in orthognathic surgery, the studies available in the literature were based on small sample size. In the presentation, I will share and discuss our experience of using TA in orthognathic surgery. Analysis of data of 545 cases operated from 2008 to 2015 will be presented.