Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS)

Objective
Mucosal bleeding during FESS often interferes with optimal visualization of the nasal surgical field and can impair the safety and efficiency of the procedure. This study was conducted to evaluate the efficacy of tranexamic acid and Epsilon Aminocaproic Acid to decrease bleeding and improve visualization of the surgical field during FESS.
Materials and methods
A total of 90 patients ASA I-II aged from 18 to 50 years and undergoing FESS for chronic sinusitis were enrolled in this study. Surgery was performed under general anesthesia patients were randomly assigned to three equal groups (30 patients each), patients in TXA group received intravenous tranexamic acid 10 mg/kg diluted in 100 ml saline. EACA group received intravenous Epsilon Aminocaproic Acid 100 mg/kg diluted in 100 ml saline and the control group received IV 100 ml normal saline (all infusions were through 10 min). The duration of surgery, volume of blood loss, pre and postoperative hemoglobin, MAP and HR, surgical field quality surgeon satisfaction and side effects were recorded.
Results
The duration of surgery was significantly less in TXA and EACA groups than the control group (121.1 ± 7.1 min), (120.8 ± 6.0 min), versus (146.1 ± 7.3 min) volume of blood loss in TXA group and EACA group was comparable (195.3 ± 32.2 ml) and (201.5 ± 30.6 ml) but each of them has significant less blood loss than the control group (365.1 ± 48.8 ml). The postoperative hemoglobin was significantly lower in the control group (11.9 ± 0.4 gm/dl) compared to TXA group (12.6 ± 0.2 gm/dl) and EACA group (12.4 ± 0.2 gm/dl). Both TXA and EACA groups had comparable improved quality of the surgical field with most of patients classified as grade 1 and 2 according to Boezaart scale while the control group had most of patients in grade 3, accordingly the surgeon satisfaction is significantly higher in TXA and EACA groups compared to the control group. No significant difference in side effects between all groups.
Conclusion
Intravenous tranexamic acid and Epsilon Aminocaproic Acid (EACA) effectively reduce bleeding during FESS and improve visualization of the surgical field and so increase the surgeon satisfaction with no significant difference between both drugs.