The Efficacy of Tranexamic Acid on the Postoperative Bleeding in Patients Receiving Head-and-Neck Surgery: A Meta-Analysis

Objectives: We assessed the effect of tranexamic acid on postoperative bleeding, and any adverse effects, in patients undergoing head-and-neck surgery. Methods: We searched databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their dates of inception to August 31, 2021. We analyzed studies that compared bleeding-related morbidity between perioperative tranexamic acid and placebo (control) groups. We subanalyzed tranexamic acid administration methods. Results: The extent of postoperative bleeding (standardized mean difference [SMD] = –0.7817, [–1.4237; –0.1398], P = 0.0170, I²= 92.2%) was significantly less in the treatment group. However, there were no significant between-group differences in terms of operative time (SMD = –0.0463 [–0.2147; 0.1221]; P = 0.5897, I²= 0.0% [0.0%; 32.9%]); intraoperative blood loss (SMD = –0.7711 [–1.6274; 0.0852], P = 0.0776, I²= 94.4%); drain removal timing (SMD = –0.3382 [–0.9547; 0.2782], P = 0.2822, I²= 81.7%); or the amount of infused perioperative fluid (SMD = –0.0622 [–0.2615; 0.1372], P = 0.5410, I²= 35.5%). Also, there were no significant between-group differences in laboratory findings (serum bilirubin, creatinine, and urea levels; and the coagulation profiles) between the tranexamic acid and control groups. Topical application was associated with a shorter postoperative drain tube dwell time than was systemic administration. Conclusion: Perioperative tranexamic acid significantly reduced postoperative bleeding in patients undergoing head-and-neck surgery. Also, topical administration might be more effective in postoperative bleeding and postoperative drain tube dwell time.