THE EFFECTS OF TWO DOSAGE REGIMENS OF TRANEXAMIC ACID ON THE INCIDENCE OF BLOOD TRANSFUSION REQUIREMENTS IN HEMI-MANDIBULECTOMY

Abstract

Intra-operative bleeding during hemi-mandibulectomy can be significant and can lead to severe consequences if
uncontrolled. Concerns about morbidities associated with significant blood loss, blood safety, continual blood shortage
and the rising cost of transfusion services during major surgeries have generated interest in the reduction of transfusion
requirements during and after surgery. Tranexamic acid (TXA), a haemostatic agent; is an antifibrinolytic agent that
competitively inhibit the activation of plasminogen to plasmin, thus inhibits the dissolution and degradation of fibrin,
stabilizes formed clot and reduces active bleeding. It has been used successfully in many surgical specialties to reduce
perioperative bleeding. The objective of this study was to compare the effectiveness of 20 mg/kg and 10 mg/kg body
weight of a single preoperative intravenous dose of tranexamic acid and 0.9% normal saline (control) on the incidence
of blood transfusion in hemi-mandibulectomy. Forty-five (45) participants, who underwent elective hemi-
mandibulectomy were included in this randomised, double blind clinical trial. A computer-based randomization
method was used in the allotment of the participants into three groups and each group with 15 participants to receive
20 mg/kg or 10 mg/kg body weight of single preoperative intravenous dose of tranexamic acid and 0.9% normal saline.
The study parameters were the demographics, the participants preoperative characteristics, units of blood transfused,
which were recorded and analysed. Data obtained were analysed using SPSS version 23.0 to compare the study groups
in terms of baseline preoperative information and intraoperative findings. The data were summarised in tables, charts
and texts. The results were expressed in percentages, mean, standard deviations, median, and interquartile range.
Changes in the quantitative variables were analysed using the one-way analysis of variance (ANOVA). The results of
the statistical tests were considered significant at p-value of < 0.05. Blood transfusion requirement was 2 units (3.6%)
in the 20 mg/kg TXA group, 17 (30.9%) units in the 10 mg/kg TXA group when compared with 36 (65.4%) units in
the control group. This study demonstrated that preoperative intravenous administration of 20 mg/kg TXA produced
a more profound clinical effect and is more effective than 10 mg/kg TXA in reducing intraoperative need for blood
transfusion during hemi-mandibulectomy.