RESUMEN
BACKGROUND: The role of tranexamic acid in the management of epistaxis remains unclear. There is uncertainty about its safety and about the contraindications for its use. We performed a systematic review of the use of systemic and topical tranexamic acid in epistaxis and a comparative review of its use in other specialties. OBJECTIVE OF REVIEW: This review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: MEDLINE and EMBASE were searched for 'epistaxis' and equivalent MESH terms, combined with the Boolean operator 'OR' and 'tranexamic acid'. The Cochrane library and society guidelines were reviewed for evidence regarding the use of tranexamic acid in other specialties. EVALUATION METHOD: All five relevant RCTs were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. RESULTS: Three RCTS pertained to spontaneous epistaxis; of these, one trial found no benefit of oral tranexamic acid in acute epistaxis, one trial found no significant benefit of topical tranexamic acid, but the largest of the trials showed significant benefit of topical tranexamic acid in acute epistaxis management. Two RCTs examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency. CONCLUSIONS: Tranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management?
Asunto(s)
Antifibrinolíticos/uso terapéutico , Epistaxis/tratamiento farmacológico , Ácido Tranexámico/uso terapéutico , Epistaxis/etiología , HumanosAsunto(s)
Glosectomía , Laringectomía , Calidad de Vida , Neoplasias de la Lengua/cirugía , Estudios de Cohortes , Deglución , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Recuperación de la Función , Estudios Retrospectivos , Habla , Tasa de Supervivencia , Neoplasias de la Lengua/mortalidad , Neoplasias de la Lengua/fisiopatología , Resultado del Tratamiento , GalesRESUMEN
BACKGROUND: Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures. METHOD: Following a systematic search of Embase, Medline and Cochrane databases (1946 - current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Three case-control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case-control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube. CONCLUSION: Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.