The Effect of Tranexamic Acid on Blood Loss During Orthognathic Surgery: A Randomized Controlled Trial

Abstract

Purpose: Tranexamic acid has been used to reduce blood loss and the subsequent need for transfusion in orthopedic, spinal, and cardiac surgery. Orthognathic surgery can be associated with significant bleeding yet its efficacy in this setting is not clear. The purpose of this study was to investigate the effect of tranexamic acid on blood loss during bimaxillary osteotomy. Patients and Methods: Seventy-three consecutive patients, scheduled for elective bimaxillary osteotomy, were included in this double blind, randomized, controlled trial. They received either a bolus of tranexamic acid (20 mg/kg) or placebo (normal saline) intravenously just before surgery. All patients received induced mild hypotension and had surgery according to a standard protocol. Intraoperative blood loss, operation time, transfusion of blood products, perioperative hemoglobin, and hematocrit were recorded. Results: The total blood loss and blood loss during maxillary surgery was reduced significantly in the tranexamic acid group compared with the control group (878.6 ± 577.7 mL vs 1,257.2 ± 817.8 mL and 428.0 ± 233.3 mL vs 643.8 ± 430.0 mL, respectively; P < .05). Considering the duration of operation and the treatment groups only, the mean total blood loss in the control group was 422 mL more than that in the tranexamic acid group (P < .001). There was no significant difference in blood transfusion or the length of hospital stay between the 2 groups. Conclusion: Preoperative intravenous bolus administration of tranexamic acid at 20 mg/kg reduces blood loss compared with placebo during bimaxillary osteotomy. © 2009 American Association of Oral and Maxillofacial Surgeons.