The use of tranexamic acid in external dacryocystorhinostomy: a systematic review and meta-analysis of randomized controlled trials.

Purpose: Tranexamic acid (TXA) is an antifibrinolytic agent effective in reducing extensive blood loss and mortality. However, it lacks significant clinical evidence in peri-ocular procedures, including dacryocystorhinostomy (DCR). This study aims to assess the effectiveness of TXA in reducing intraoperative hemorrhage and improving surgical outcomes.

Methods: We searched PubMed, Medline, ClinicalTrials.gov, and the Cochrane Library, along with grey literature sources from the year 2000 onwards for randomized controlled trials (RCTs). We used the revised Cochrane Risk of Bias tool (RoB 2.0) to assess quality. RevMan 5.4 was used to conduct all statistical analyses using a random-effects model.

Results: A meta-analysis was performed on 448 patients from 5 RCTs. Between TXA and placebo group, a statistically significant reduction in intraoperative bleeding, a statistically non-significant reduction in total surgical time and recovery time, a statistically significant increase in surgeon satisfaction, and no statistically significant difference in anesthesia time were observed. A comparison of topical TXA with placebo in one study showed a statistically significant reduction in intraoperative bleeding and total surgical time. Between TXA and the other interventions, including remifentanil and hydralazine, no statistically significant differences in intraoperative bleeding, total surgical time, recovery time, surgeon satisfaction, and anesthesia time were observed.

Conclusion: Evidence shows the superiority of TXA in reducing intraoperative bleeding and increasing surgeon satisfaction in patients undergoing DCR, improving surgical outcomes and recovery time. Further studies are needed to evaluate the effectiveness of TXA in ocular procedures.