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A Systematic Review on the efficacy of Tranexamic acid in Head and Neck Surgery
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  • Warda Jamshaid,
  • Maryam Jamshaid,
  • Jameel Muzaffar,
  • Hannah Nieto,
  • Chris Coulson,
  • Neil SHARMA
Warda Jamshaid
University of Birmingham

Corresponding Author:[email protected]

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Maryam Jamshaid
Cardiff University
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Jameel Muzaffar
Queen Elizabeth Hospital
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Hannah Nieto
University Hospitals Birmingham NHS Foundation Trust
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Chris Coulson
Queen Elizabeth Hospital
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University Hospitals Birmingham NHS Foundation Trust
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Background: Intra and post-operative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intra and post-operative bleeding, however reported results are variable. Objectives: To determine the safety and efficacy of tranexamic acid use in Head and Neck surgery. Methods: Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of post-operative drain or return to theatre rate for post-operative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for RCTs and NOS tool for non-randomised studies. Results: 16 studies were identified (114, 407 patients). 8 studies evaluated TXA in major H&N surgery and 8 studies in tonsillectomy. Primary outcomes were reduction in intraoperative or post-operative bleeding. Secondary outcomes included the duration of post-operative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intra-operative blood loss in tonsillectomy. However, the effect on post-tonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intra-operative bleeding in major H&N procedures. Post-operative bleeding rates were substantially reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. Conclusion: TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery. Key words: Tranexamic acid, Head and Neck surgery, thyroidectomy, tonsillectomy
04 Nov 2022Submitted to Clinical Otolaryngology
26 Dec 2022Submission Checks Completed
26 Dec 2022Assigned to Editor
02 Jan 2023Reviewer(s) Assigned
16 Jan 2023Review(s) Completed, Editorial Evaluation Pending
29 Jan 2023Editorial Decision: Revise Major
08 Feb 20231st Revision Received
09 Feb 2023Submission Checks Completed
09 Feb 2023Assigned to Editor
15 Feb 2023Reviewer(s) Assigned
16 Feb 2023Review(s) Completed, Editorial Evaluation Pending
19 Feb 2023Editorial Decision: Accept