Publication date: Available online 30 January 2019
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Kalliopi Siotou, Charalampos Siotos, Armina Azizi, Michael A. Cheah, Stella M. Seal, Richard J. Redett, Gedge D. Rosson
Abstract
Purpose
Use of anti-fibrinolytic drugs in craniofacial and orthognathic surgery seems quite promising and has strong advocates. However, supporting evidence is controversial and limited by a small sample of individual studies. We sought to systematically review and meta-analyze the available data regarding the role of pre- or intra-operative anti-fibrinolytic drugs (e.g., tranexamic acid, aprotinin, aminocaproic acid) in craniofacial and orthognathic surgery.
Materials and Methods
We searched PubMed, Scopus, Embase, Cochrane Libray, and Web of Science through April 19, 2018, according to PRISMA guidelines. Outcomes of interest included the volume of blood loss, transfusions, and operative time. A meta-analysis was performed employing the Random Effects Model using the RevMan software.
Results
We identified 32 eligible studies with 749 patients undergoing craniofacial and 546 orthognathic surgery. Meta-analysis shows that anti-fibrinolytics use led to statistically significant decreases in blood loss and blood transfusions for craniofacial procedures in adult or pediatric patients, and significantly less blood loss during orthognathic surgeries. Operative time did not significantly differ for either type of surgery.
Conclusions
Anti-fibrinolytics can significantly reduce blood loss in craniofacial surgeries including pediatric craniosynostosis, adult rhinoplasties and orthognathic surgeries, and transfusion requirements in pediatric craniofacial surgeries. However, clinical significance of the medications is still questionable due to relative paucity of information on adverse effects and the usual small volume loss during those operations.
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