The Effect Of Tranexamic Acid During Sagittal Split Ramus Osteotomy

Objectives: Bleeding during major surgical interventions is associated with unstable hemodynamics, and increases morbidity and mortality. Therefore, therapeutic inhibition of fibrinolysis has been applied for reducing bleeding in various clinical situations. However, the therapeutic effectiveness of inhibition of fibrinolysis has not been clarified in detail in dental surgery.
Thus, we retrospectively compared the hemostatic effects of tranexamic acid, which is an antifibrinolytic, in patients intravenously administered with tranexamic acid (tranexamic acid group) and those not administered with the drug (not administered group) during bilateral sagittal split ramus osteotomy.
Methods: This study was approved by the research ethics committee of Hiroshima University Hospital (approval number: E-1332). The subjects were 30 women (17- to 26-year-old) with ASA physical status I who underwent a bilateral sagittal split ramus osteotomy under general anesthesia. All surgical procedures were performed by the same oral surgeon. We compared the operation time, the doses of local anesthetic agent, and the amount of bleeding in the tranexamic acid group (n = 15) and the not administered group (n = 15). All data were extracted from anesthesia records and analyzed using Student’s t-test. The results were considered statistically significant when p < 0.05.
Results: Although no significant difference was detected in the doses of local anesthetic agent (p > 0.05), significant differences were observed in the operation time (tranexamic acid group: 141.3 ± 16.8 min vs. not administered group: 166.8 ± 24.9 min; p = 0.03) and the amount of bleeding (tranexamic acid group: 161.7 ± 45.3 mL vs. not administered group: 270.2 ± 24.0 mL; p = 0.0009) between the groups.
Conclusions: The administration of tranexamic acid during bilateral sagittal split ramus osteotomy significantly decreases the operation time and the amount of bleeding. Therefore, tranexamic acid may be useful for avoiding the adverse outcomes due to bleeding during dental surgery.