Evaluation of the effectiveness of different dose application protocols of tranexamic acid in bleeding, edema and surgeon comfort in bimaxillary orthognathic surgery patients

Orthognathic surgery is a frequently performed procedure aimed at correcting dentofacial deformities, restoring oral functions, and achieving facial harmony. Despite its advantages, complications may arise during these surgeries. Numerous studies have focused on the use of antifibrinolytic agents, particularly tranexamic acid, to reduce bleeding and the need for allogeneic transfusion in surgical patients. Tranexamic acid is an effective antifibrinolytic agent for hemorrhages caused by primary hyperfibrinolysis, conditions with a risk of secondary hemorrhage, and bleeding occurring in tissues rich in plasminogen activators. The reduction of edema, ecchymosis, and erythema, minimizing blood loss and patient morbidity, and increasing patient satisfaction demonstrate the potential benefits of these applications in surgical procedures.This prospective, double-blind, randomized study of 72 patients aimed to investigate the effects of the two-dose tranexamic acid (TXA) protocol for managing edema during orthognathic surgery. The participants were randomly assigned to three groups as follows,Group 1:TXA 250:One intravenous (IV) dose of 250 mg TXA prior to incision,Group 2:TXA 500: One IV dose of 250 mg TXA prior to incision,and a second dose of 250 mg TXA after completion of the first jaw(or after 2h), Group 3:Control; No TXA. Measurements for edema were done preoperatively and repeated on postoperative days 1, 3, and 7 to assess postoperative edema. Our results showed that rebound swelling in Tra-Co distance when comparing the three groups: on day 3, between Group 2 and the control group (p = 0.037), and on day 7, again between Group 2 and the control group revealed significant differences (p = 0.002). Bleeding was significantly higher(p< 0.001) and the Fromme scale scores were significantly lower (p< 0.001) in the control group (Group 3) relative to TXA groups. The TXA 500 group suggests that a 500 mg dose may be more effective in reducing edema compared to both the control group and the TXA 250 group, alleviating complications, and speeding up the patient's overall recovery following orthognathic surgery. Keywords: tranexamic acid, orthognathic surgery, edema, patient comfort, treatment outcome, hemorrhage