Page 83 - Revista Portuguesa - SPORL - Vol 62. Nº1
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– 1.38, p < 0.001) and SFQ (combined effect alleviate epistaxis , with the advantage of
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size of – 0.78, p < 0.001). No differences were being less uncomfortable and damaging to
observed between topical and intravenous the nasal mucosa than nasal packing . The
24
TXA concerning v BL (p = 0.54) or SFQ (p = 0.94). hemostatic mechanism of HSI is unknown, but
it may include edema and narrowing of the
Discussion intranasal lumen, which contributes to vessel
There is a close association between intra- compression; decreased flow and intraluminal
operative bleeding and surgical field quality in blood pressure due to mucosal vasodilation; or
FESS . Adequate visualization during FESS is cleaning of blood coagulates from the nose .
25
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critical for total disease eradication and avoiding The resulting decrease in diffuse mucosal
complications 1,2,15 . When SFQ is compromised, oozing is pointed out as one important aspect
orbital or skull base iatrogenic injuries may of SFQ improvement with HSI . Another key
26
ensue . Additionally, intra-operative bleeding advantage of HSI is that it allows the cleaning
15
causes multiple interruptions during surgery of the endoscopic lens . Local acting effects
1,3
for suctioning and packing, which may increase could help to explain why HSI proved superior
surgical time. Hence, exploring adjuvant to TXA in reducing vBL in our study. In HIS there
therapeutics to maximize operatory conditions is is always local administration, contrasting to
essential. This study´s primary purpose was to systemic administration in many TXA studies.
compare HSI and TXA regarding vBL, SFQ, and We wonder if this fact could potentiate a more
DS. The primary objective of this work was met. localized modulation of bleeding mechanisms.
HSI presented a more significant reduction On the other hand, the comparison between
in vBL compared to TXA. Considering SFQ, topical versus intravenous TXA administration
both HSI and TXA were significantly superior did not show significant differences between
to controls, and no significant difference was groups concerning vBL and SFQ, since both
found between HSI and TXA. Concerning the were seemingly effective on ameliorating
DS, there were no significant DS differences these outcomes. With inherent antifibrinolytic
between HSI and TXA patients. Nevertheless, action, TXA acts by competitive binding
only in the TXA group DS was significantly with the lysine site on plasminogen . This
3
reduced compared to controls (probably due reduces bleeding by preventing fibrinolysis
to a larger sample size). The only existent study and stabilizing blood clots. In line with our
directly comparing HSI and TXA is the one results, former meta-analyses 2,16–19 concluded
from Shehata et al . In this trial, three groups, the effectiveness of topical and systemic TXA
3
TXA 1000 mg diluted in 20 ml saline, 50ºc HSI, in reducing blood loss and improving SFQ in
and normal saline were used for packing and FESS. Likewise, in our systematic review, most
irrigation during FESS. The use of local TXA of the studies showed favorable outcomes with
and HSI up to 50°C achieved a significant the use of TXA. Only the study from Langille
reduction in vBL and DS, while improving et al failed to show a beneficial association
9
SFQ. Notably, no significant differences were between TXA and intraoperative bleeding in
observed between TXA and HSI groups. These FESS. When scrutinizing the results of that
findings are partially in line with our results. same study , one can find that there was a
9
Although we found a significantly reduced median of 115 ml blood loss in cases versus
vBL in the HSI group compared to the TXA, this 200 ml in controls, and the median DS was
did not translate into higher SFQ or reduced 10 minutes shorter in the TXA group. Hence,
DS. Consistent with our findings, a previous neither vBL nor DS reached significance
meta-analysis reported that the use of HSI probably due to a limited sample size of 14
provides a good hemostatic effect during patients, which was too small to accommodate
FESS to control intraoperative bleeding and significance. In our study, TXA showed a
obtain superior SFQ . HSI were first used to significant shorter DS compared to controls,
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