Intravenous Tranexamic Acid in Rhinoplasty: A Randomized Controlled Trial

<b>Background:</b> Existing data on tranexamic acid (TXA) in rhinoplasty are mixed. <b>Objective:</b> Compare blood loss, edema, and bruising in patients undergoing septorhinoplasty with or without intravenous (IV) TXA, measured by estimated blood loss and photograph review of edema/ecchymosis. <b>Design:</b> Randomized controlled trial (NCT05774717). <b>Methods:</b> Patients undergoing open septorhinoplasty were eligible. Participants were randomized to receive 1 g IV TXA preoperatively or routine medications only. Intraoperative bleeding was measured using the Boezaart scale and sponge saturation. Patients rated periorbital edema/ecchymosis at 1 week. Photos were reviewed by a facial plastic surgeon to grade edema/ecchymosis. <b>Results:</b> There were 139 participants: 73 (53%) female, mean age of 42 ± 15 years, and 13% revision procedures. Sixty-nine (50%) received TXA. Boezaart scores were 2.25 and 2.41 (<i>p</i> = 0.3), and sponge scores were 0.76 and 0.84 (<i>p</i> = 0.4) in the TXA and control groups, respectively. Postoperative edema/ecchymosis were 1.15/1.19 out of 4 in the TXA group, and 0.97/1.05 in the control group. Surgeon-graded edema/ecchymosis were 1.78/1.76 (TXA) and 1.82/1.86 (control). There was no difference in epistaxis, pain, or appearance satisfaction. <b>Conclusions:</b> In this study, there was no difference in bleeding, edema, ecchymosis, or postoperative experience associated with TXA.