Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial

PLoS One. 2014 Aug 18;9(8):e104477. doi: 10.1371/journal.pone.0104477. eCollection 2014.


Background: The effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet. This study was conducted to answer this question.

Methods: This trial was conducted on 60 patients with chronic sinusitis at Beasat Hospital, Hamadan, Iran, from April to November 2013. Thirty patients in the intervention group received three pledgets soaked with TXA 5% and phenylephrine 0.5% for 10 minutes in each nasal cavity before surgery. Thirty patients in the control group received phenylephrine 0.5% with the same way. The amount of bleeding and the quality of surgical field were evaluated at 15, 30, and 45 minutes after the start of surgery using Boezaart grading.

Results: The quality of the surgical field in the intervention group compared to the control group was significantly better in the first quarter (P = 0.002) and the second quarter (P = 0.003) but not in the third quarter (P = 0.163). Furthermore, the amount of bleeding was much less during all periods in the intervention group than in the control group (P = 0.001).

Conclusion: Topical TXA can efficiently reduce bleeding and improve the surgical field in FESS in patients with rhinosinusitis. Based on these findings, topical TXA may be a useful method for providing a suitable surgical field during the first 30 minutes after use.

Trial registration: Iranian Registry of Clinical Trials IRCT201212139014N15.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Antifibrinolytic Agents / administration & dosage*
  • Blood Loss, Surgical / prevention & control
  • Chronic Disease
  • Drug Therapy, Combination
  • Endoscopy
  • Epistaxis / prevention & control
  • Female
  • Hemostasis, Surgical
  • Humans
  • Male
  • Middle Aged
  • Phenylephrine / therapeutic use
  • Rhinitis / surgery*
  • Sinusitis / surgery*
  • Tranexamic Acid / administration & dosage*
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use
  • Young Adult


  • Antifibrinolytic Agents
  • Vasoconstrictor Agents
  • Phenylephrine
  • Tranexamic Acid

Associated data

  • IRCT/IRCT201212139014N15

Grant support

This study was funded by the Vice-chancellor of Research and Technology, Hamadan University of Medical Sciences. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.