Intravenous Tranexamic Acid in Rhinoplasty: A Randomized Controlled Trial.

Existing data on tranexamic acid (TXA) in rhinoplasty are mixed. Compare blood loss, edema, and bruising in patients undergoing septorhinoplasty with or without intravenous (IV) TXA, measured by estimated blood loss and photograph review of edema/ecchymosis. Randomized controlled trial (NCT05774717). Patients undergoing open septorhinoplasty were eligible. Participants were randomized to receive 1 g IV TXA preoperatively or routine medications only. Intraoperative bleeding was measured using the Boezaart scale and sponge saturation. Patients rated periorbital edema/ecchymosis at 1 week. Photos were reviewed by a facial plastic surgeon to grade edema/ecchymosis. There were 139 participants: 73 (53%) female, mean age of 42 ± 15 years, and 13% revision procedures. Sixty-nine (50%) received TXA. Boezaart scores were 2.25 and 2.41 ( = 0.3), and sponge scores were 0.76 and 0.84 ( = 0.4) in the TXA and control groups, respectively. Postoperative edema/ecchymosis were 1.15/1.19 out of 4 in the TXA group, and 0.97/1.05 in the control group. Surgeon-graded edema/ecchymosis were 1.78/1.76 (TXA) and 1.82/1.86 (control). There was no difference in epistaxis, pain, or appearance satisfaction. In this study, there was no difference in bleeding, edema, ecchymosis, or postoperative experience associated with TXA.