Purpose

Tranexamic acid (TXA) is an antifibrinolytic agent effective in reducing extensive blood loss and mortality. However, it lacks significant clinical evidence in peri-ocular procedures, including dacryocystorhinostomy (DCR). This study aims to assess the effectiveness of TXA in reducing intraoperative hemorrhage and improving surgical outcomes.

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Methods

We searched PubMed, Medline, ClinicalTrials.gov, and the Cochrane Library, along with grey literature sources from the year 2000 onwards for randomized controlled trials (RCTs). We used the revised Cochrane Risk of Bias tool (RoB 2.0) to assess quality. RevMan 5.4 was used to conduct all statistical analyses using a random-effects model.

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Results

A meta-analysis was performed on 448 patients from 5 RCTs. Between TXA and placebo group, a statistically significant reduction in intraoperative bleeding, a statistically non-significant reduction in total surgical time and recovery time, a statistically significant increase in surgeon satisfaction, and no statistically significant difference in anesthesia time were observed. A comparison of topical TXA with placebo in one study showed a statistically significant reduction in intraoperative bleeding and total surgical time. Between TXA and the other interventions, including remifentanil and hydralazine, no statistically significant differences in intraoperative bleeding, total surgical time, recovery time, surgeon satisfaction, and anesthesia time were observed.

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Conclusion

Evidence shows the superiority of TXA in reducing intraoperative bleeding and increasing surgeon satisfaction in patients undergoing DCR, improving surgical outcomes and recovery time. Further studies are needed to evaluate the effectiveness of TXA in ocular procedures.

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Additional Authors

First name	Last name	Base Hospital / Institution
Shameer Iqbal	Ghuman	King Edward Medical University, Lahore, Pakistan
Ishmal Fatima	Shahid	King Edward Medical University, Lahore, Pakistan
Muhammad Imaz	Bhatti	King Edward Medical University, Lahore, Pakistan
Jawad	Ahmad	King Edward Medical University, Lahore, Pakistan
Zainab	Jamil	King Edward Medical University, Lahore, Pakistan
Abeeha	Fatima	King Edward Medical University, Lahore, Pakistan
Azka	Ijaz	King Edward Medical University, Lahore, Pakistan
Eilaf	Azeem	International School Lahore, Lahore, Pakistan
Muhammad Ahmad	Tariq	Pakistan International School, Jeddah, Kingdom of Saudi Arabia

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