Tranexamic acid is an antifibrinolytic drug that has proven to be effective in reducing perioperative blood loss in a myriad of clinical circumstances. In this manuscript the authors present a randomized controlled trial of tranexamic acid in patients undergoing orthognathic surgery. Fifty consecutive patients were included and were randomized for tranexamic acid (10 mg/kg bolus followed by 1 mg/kg maintenance) or placebo. The authors observed a statistically significant reduction in blood loss (166 mL in the tranexamic acid group versus 256 mL in the control group) and improved quality of surgical field, as assessed by a standardized but subjective score. It is important to mention, however, that in absolute terms the reduction in blood loss was very modest and not very relevant and – again in absolute terms – the quality of the surgical field was quite good in both groups. This, in combination with no difference in duration of surgery and transfusion requirements between the two groups, makes this observation basically interesting, as it adds confirmation to the prohemostatic potential of tranexamic acid, but clinically not very relevant.
– Marcel Levi