The Safety of Topical and Intravenous Tranexamic Acid in Endoscopic Sinus Surgery

Tranexamic acid (TXA) is an inexpensive and widely used medication indicated for the reduction of bleeding. There are data showing the efficacy of intravenous (IV) and topical TXA in endoscopic sinus surgery (ESS) but the safety of this practice is not well studied. The objective of this study was to assess the safety of using both IV and topical TXA in ESS. A scoping review was performed to investigate the effect of TXA on respiratory epithelia. A retrospective single-surgeon study was used to assess 177 comprehensive ESS cases from January 2017–December 2019 for the safety of combined IV and topical TXA. The scoping review demonstrated that respiratory epithelia could withstand a wide range of TXA concentrations without detrimental morphological effects. Topical TXA may have positive effects on wound healing and inflammation. The retrospective study showed no thromboembolic complications attributable to TXA in the 28 days after ESS. Only two patients (1.3%) who received TXA re-presented with post-operative bleeding. The use of IV and topical TXA is safe with regards to its effect on respiratory epithelium and thromboembolic disease. Topical TXA may have more positive effects than merely the reduction of bleeding following ESS.