Evidence map›Paper›PMID 39580557›Full record

SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2025

Tranexamic acid in endoscopic sinus surgery: an updated systematic review and meta-analysis of randomized controlled trials.

Ebraheem Albazee, Ammar H Alabsi, Salman Hussain, Abdullah S Alghamdi, Ahmed Abu-Zaid

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Ebraheem Albazee *Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.ORCID https://orcid.org/0000-0003-1244-7769
Ammar H Alabsi *Department of Medicine, Specialized Medical Center Hospital, Riyadh, Saudi Arabia.
Salman HussainDepartment of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0001-7287-7694
Abdullah S AlghamdiDepartment of Otorhinolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia.
Ahmed Abu-ZaidCollege of Medicine, Alfaisal University, Riyadh, Saudi Arabia. amabuzaid@alfaisal.edu.ORCID http://orcid.org/0000-0003-2286-2181

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo conduct an updated meta-analysis evaluating the efficacy and safety of tranexamic acid (TXA) versus control during endoscopic sinus surgery.

methodsSix databases were screened until July 7, 2024, and the quality of included randomized controlled trials (RCTs) was assessed. Endpoints were summarized as mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model.

resultsA total of 23 RCTs, including 29 arms and 1597 patients, were analyzed. The overall quality was rated as low-risk in 15 RCTs, high-risk in five RCTs, and of some concern in three RCTs. TXA significantly reduced intraoperative blood loss (n = 22 arms, MD = - 68.87 ml, 95% CI - 79.66, - 58.07) and operative time (n = 21 arms, MD = - 13.93 min, 95% CI - 17.49, - 10.37) compared to control. TXA also improved surgical field quality (measured on a 5-point Boezaart scale, n = 22 arms, MD = - 0.61, 95% CI - 0.88, - 0.34) and surgeon satisfaction scores (n = 9 arms, MD = 0.85, 95% CI 0.53, 1.17). No thromboembolic events were reported in either group. Leave-one-out sensitivity analyses confirmed the robustness of all endpoints, and no publication bias was detected. Subgroup analyses by route of administration (intravenous, topical, and oral) showed equal effectiveness. Additionally, analyses by sinus pathology demonstrated effectiveness in patients with severe chronic rhinosinusitis with nasal polyposis (CRSwNP). Trial sequential analysis showed conclusiveness for all outcomes.

conclusionPerioperative TXA, whether administered systemically or topically, correlates with decreased intraoperative blood loss, shortened operating times, and enhanced surgical visualization compared to control interventions. However, these findings are constrained by significant heterogeneity and varying reporting quality among studies.

Indexed as

Antifibrinolytic AgentsBlood Loss, SurgicalEndoscopyParanasal SinusesSinusitisTranexamic AcidHumansOperative TimeRandomized Controlled Trials as TopicAntifibrinolytic AgentsTranexamic AcidChronic rhinosinusitisEndoscopic sinus surgeryMeta-analysisTranexamic acid

Identifiers

PMID39580557

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.