Evaluating the Efficacy of Tranexamic Acid versus Placebo in Controlling Intraoperative Blood Loss during Mandibular Fracture Surgeries

Original Article

Abstract

Objective: To determine the efficacy of intravenous tranexamic acid versus placebo in reducing intraoperative blood loss in patients undergoing mandibular fracture surgery, and the effect of tranexamic acid on postoperative fall in hemoglobin, need for transfusion, and operative time.

Methodology: This was a randomized, placebo-controlled study. Oral & Maxillofacial Surgery, Bolan Medical College  Hospital, Quetta. From March 2025 to August 2025, we treated 100 patients surgically for mandibular fractures. Patients were randomly divided into two groups, A (n=50) and B (n=50); group A received intravenous tranexamic acid, and group B received placebo. Patients in the age range of 18-65 years, who presented with mandibular fractures diagnosed on radiographs and were treated operatively, were included. SPSS was used for data analysis. We used an independent-samples t-test to compare continuous variables and a chi-square test to compare categorical variables. We considered p < 0.05 statistically significant.

Results: We included 100 patients, with 50 in each treatment group. The overall mean age was 34.8 ± 9.7 years. Patients receiving tranexamic acid had a mean age of 35.2 ± 9.5 years, whereas those receiving placebo had a mean age of 34.4 ± 9.9 years (p=0.68). The mean intraoperative blood loss was significantly lower in the tranexamic acid group (285 ± 85 mL) compared with the placebo group (410 ± 110 mL, p<0.001). The mean postoperative hemoglobin reduction was also lower among patients receiving tranexamic acid (1.2 ± 0.6 g/dL) than among placebo recipients (1.8 ± 0.8 g/dL, p<0.001). Blood transfusion was required in 3 patients (6.0%) in the tranexamic acid group compared with 10 patients (20.0%) in the placebo group (p=0.037). Mean operative duration was 118 ± 24 minutes in the tranexamic acid group and 126 ± 27 minutes in the placebo group (p=0.12). No major thromboembolic or other serious adverse events were observed in either group. These findings suggest that tranexamic acid significantly reduces intraoperative blood loss and postoperative hemoglobin decline during mandibular fracture surgery.

Conclusion: Intraoperative blood loss and postoperative hemoglobin loss were significantly reduced in patients receiving tranexamic acid intravenously for surgery on mandibular fracture. It also reduced the need for blood transfusion peroperatively without significantly affecting surgery duration. Tranexamic acid may be beneficial and appears relatively safe as an adjunct for controlling surgical blood loss in mandibular fracture surgery. More centrally controlled, randomized studies are needed to validate these results and provide a uniformly accepted dosing protocol.