Page 84 - Revista Portuguesa - SPORL - Vol 62. Nº1

opposing to HSI in which significance was not Conclusion
reached. We wonder if this is explained by: 1)
TXA administration not being dependent on
the surgeon (when intravenous administration
is used) or 2) TXA being applied only once in a
while when topically, as opposed to HSI, which
requires multiple repeated administrations
throughout the surgery, making it more time-
consuming. TXA´s most prevalent side effects
are gastrointestinal, including postoperative
nausea and vomiting. However, the incidence
of these side events is modest . A rapid bolus
18
dose might produce substantial hypotension
when administered intravenously .Nevertheless,
27
recent studies show that adverse effects of TXA
are dose-dependent and infrequent at the
recommended dosages . Many of the enrolled
18
trials used safe administration techniques
such as gradual injection and safe dosages
between 10-15 mg/kg. Despite TXA´s safety and
tolerance, the possibility of thromboembolic
events has raised concerns. Nevertheless,
current studies demonstrate that TXA does
not significantly increase the incidence
of thromboembolism when compared to
controls . This study has limitations. As with
18
every systematic review and meta-analysis,
there is a certain risk of publication bias.
Moreover, the included studies differ in their
design and methodologies, resulting in
considerable heterogeneity in reports. There
are several surgical approaches within FESS,
and the experience of surgeons and baseline
pathology may have varied between cases and
controls, as this is not always reported. Besides,
even with proper preoperative coagulation
and platelet count tests (performed in most
studies) it is impossible to account for the
subclinical and interindividual susceptibility to
bleeding, which may have compromised the
analysis. Overall, results should be appraised
critically as a result of research heterogeneity.
Our study has its own strengths, as it is the
first meta-analysis to compare HSI and TXA
effectiveness in bleeding-related outcomes in
FESS.
84 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
Bleeding during FESS continues to
be a problem for both surgeons and
anesthesiologists. This study suggests that
the use of HSI or TXA in FESS can improve
operative conditions while reducing blood
loss. Both are effective in reducing blood loss
(with a marginal advantage in HIS in vBL), and
no differences were found between the two
modalities relating to SFQ and DS. TXA has the
advantage of being easy to apply, especially
when used intravenously. HIS on the other
hand may help to clean the endoscope lens
and remove blood clots from the field. Studies
focusing on the synergic effect of applying
both TXA and HSI could also be relevant to
affirm their role in daily practice.
Conflict of Interests
The authors declare that they have no conflict
of interest regarding this article.
Data Confidentiality
The authors declare that they followed the
protocols of their work in publishing patient
data.
Human and animal protection
The authors declare that the procedures
followed are in accordance with the regulations
established by the directors of the Commission
for Clinical Research and Ethics and in
accordance with the Declaration of Helsinki of
the World Medical Association.
Privacy policy, informed consent and Ethics
committee authorization
All the processed data were based in published
reports that fulfilled privacy policy and ethical
considerations.
Financial support
This work did not receive any grant contribution,
funding or scholarship.
Scientific data availability
There are no publicly available datasets related
to this work.