J Korean Assoc Oral Maxillofac Surg.  2023 Aug;49(4):208-213. 10.5125/jkaoms.2023.49.4.208.

Effectiveness of hemocoagulase, tranexamic acid, and their combination for reducing blood loss in bimaxillary orthognathic surgery: a retrospective study

• Kim MS
• Han SJ

• KMID: 2545586
• DOI: http://doi.org/10.5125/jkaoms.2023.49.4.208

Abstract

Objectives
Orthognathic surgery is a corrective intervention for maxillofacial deformities. Bleeding is a major concern for oral and maxillofacial surgeons. Various agents, such as hemocoagulase, tranexamic acid, and aprotinin have been developed to reduce intraoperative bleeding and transfusion requirements. Therefore, in this study we aimed to investigate the effects of hemocoagulase and tranexamic acid, as well as their simultaneous use, to reduce bleeding during orthognathic surgery.
Patients and Methods
This retrospective study included patients who had undergone simultaneous orthognathic surgery of the maxilla and mandible between January 2013 and September 2022 and were classified into three groups based on drugs administered: hemocoagulase (Botropase), tranexamic acid, and a combination of both drugs. We recorded patient age, sex, weight, blood loss, and duration of surgery. Red blood cell (RBC), hemoglobin, hematocrit, and platelet levels were measured before, immediately after, and one day after surgery.
Results
No statistically significant differences were found in blood loss, RBC, hemoglobin, hematocrit, or platelet levels between any of the groups. There were no differences in the drug effects between Le Fort I and bilateral mandibular sagittal split osteotomies, with or without double genioplasty. However, there were significant reductions in RBC, hemoglobin, hematocrit, and platelet levels during genioplasty.
Conclusion
Tranexamic acid, hemocoagulase, and their combination had similar efficacy in patients who underwent Le Fort Ⅰ and bilateral mandibu-lar sagittal split osteotomies with and without genioplasty.

Keyword

Orthognathic surgery; Tranexamic acid; Hemocoagulase

Reference

References

1. Thastum M, Andersen K, Rude K, Nørholt SE, Blomlöf J. 2016; Factors influencing intraoperative blood loss in orthognathic surgery. Int J Oral Maxillofac Surg. 45:1070–3. https://doi.org/10.1016/j.ijom.2016.02.006. DOI: 10.1016/j.ijom.2016.02.006. PMID: 27055979.

2. Jeong J, Portnof JE, Kalayeh M, Hardigan P. 2016; Hypotensive anesthesia: comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery. J Craniomaxillofac Surg. 44:854–8. https://doi.org/10.1016/j.jcms.2016.04.009. DOI: 10.1016/j.jcms.2016.04.009. PMID: 27193474.

3. Apipan B, Rummasak D. 2010; Efficacy and safety of oral propranolol premedication to reduce reflex tachycardia during hypotensive anesthesia with sodium nitroprusside in orthognathic surgery: a double-blind randomized clinical trial. J Oral Maxillofac Surg. 68:120–4. https://doi.org/10.1016/j.joms.2009.07.065. DOI: 10.1016/j.joms.2009.07.065. PMID: 20006165.

4. Oh AY, Seo KS, Lee GE, Kim HJ. 2016; Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis. Int J Oral Maxillofac Surg. 45:486–9. https://doi.org/10.1016/j.ijom.2015.11.008. DOI: 10.1016/j.ijom.2015.11.008. PMID: 26678802.

5. Mei A, Qiu L. 2019; The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 48:1323–8. https://doi.org/10.1016/j.ijom.2018.07.027. DOI: 10.1016/j.ijom.2018.07.027. PMID: 30902548.

6. Nagabhushan RM, Shetty AP, Dumpa SR, Subramanian B, Kanna RM, Shanmuganathan R. 2018; Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 43:E267–73. https://doi.org/10.1097/brs.0000000000002315. DOI: 10.1097/BRS.0000000000002315. PMID: 28678111.

7. Andersen K, Thastum M, Nørholt SE, Blomlöf J. 2016; Relative blood loss and operative time can predict length of stay following orthognathic surgery. Int J Oral Maxillofac Surg. 45:1209–12. https://doi.org/10.1016/j.ijom.2016.05.015. DOI: 10.1016/j.ijom.2016.05.015. PMID: 27267706.

8. Eftekharian H, Vahedi R, Karagah T, Tabrizi R. 2015; Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. J Oral Maxillofac Surg. 73:129–33. https://doi.org/10.1016/j.joms.2014.07.033. DOI: 10.1016/j.joms.2014.07.033. PMID: 25443384.

9. Braud S, Bon C, Wisner A. 2000; Snake venom proteins acting on hemostasis. Biochimie. 82:851–9. https://doi.org/10.1016/s0300-9084(00)01178-0. DOI: 10.1016/S0300-9084(00)01178-0. PMID: 11086215.

10. Shetty V, Sriram SG. 2015; Effectiveness of intravenous haemocoagulase on haemorrhage control in bi-maxillary orthognathic surgery-a prospective, randomised, controlled, double-blind study. J Craniomaxillofac Surg. 43:2000–3. https://doi.org/10.1016/j.jcms.2015.08.032. DOI: 10.1016/j.jcms.2015.08.032. PMID: 26454322.

11. Liang J, Liu H, Huang X, Xiong W, Zhao H, Chua S, et al. 2016; Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: a randomized control trial. Clin Neurol Neurosurg. 147:110–4. https://doi.org/10.1016/j.clineuro.2016.06.001. DOI: 10.1016/j.clineuro.2016.06.001. PMID: 27343711.

12. Zellin G, Rasmusson L, Pålsson J, Kahnberg KE. 2004; Evaluation of hemorrhage depressors on blood loss during orthognathic surgery: a retrospective study. J Oral Maxillofac Surg. 62:662–6. https://doi.org/10.1016/j.joms.2004.02.001. DOI: 10.1016/j.joms.2004.02.001. PMID: 15170275.

13. Xu C, Wu A, Yue Y. 2012; Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tranexamic acid or a combination? Arch Orthop Trauma Surg. 132:25–31. https://doi.org/10.1007/s00402-011-1390-6. DOI: 10.1007/s00402-011-1390-6. PMID: 21909815.

14. Christabel A, Muthusekhar MR, Narayanan V, Ashok Y, Soh CL, Ilangovan M, et al. 2014; Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies--a prospective, triple blinded randomized clinical trial. J Craniomaxillofac Surg. 42:1221–4. https://doi.org/10.1016/j.jcms.2014.03.003. DOI: 10.1016/j.jcms.2014.03.003. PMID: 24776218.

15. Choi WS, Irwin MG, Samman N. 2009; The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg. 67:125–33. https://doi.org/10.1016/j.joms.2008.08.015. DOI: 10.1016/j.joms.2008.08.015. PMID: 19070758.

16. Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q. 2013; The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 115:595–600. https://doi.org/10.1016/j.oooo.2012.09.085. DOI: 10.1016/j.oooo.2012.09.085. PMID: 23260768.