Tranexamic acid can reduce blood loss and improve visibility in otological surgeries: a systematic review and meta-analysis of randomised controlled trials.

Abstract

<h4>Objectives</h4>The objective of the study was to determine the effect of tranexamic acid in ear surgeries on duration of surgery, intra-operative blood loss, visibility and mean arterial pressure (MAP).<h4>Methods</h4>A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. Five databases were used (PubMed, Cochrane, Scopus, Web of Science and Embase). A search yielded 73 articles: 31 were duplicates and 42 were screened for by two authors. A standardised mean difference (SMD) was calculated to measure the effect size across studies.<h4>Results</h4>The search yielded five final studies with ear procedures including tympanoplasty, atticotomy, mastoidectomy, ossiculoplasty, stapedotomy, tympanotomy and microscopic modified radical mastoidectomy. Tranexamic acid reduced duration of surgery (standardised mean difference = -3.82; <i>p</i> = 0.38), intra-operative blood loss (standardised mean difference = -19.64; <i>p</i> < 0.05) and mean arterial pressure (standardised mean difference = -2.88; <i>p</i> < 0.05).<h4>Conclusion</h4>This meta-analysis demonstrated that tranexamic acid reduced bleeding and mean arterial pressure that were both statistically significant, while the reduction in duration of surgery was statistically insignificant. All studies reported better visibility.