The role of tranexamic acid in orthognathic surgery: an umbrella review

Abstract

Background: Tranexamic acid (TXA), an antifibrinolytic agent, is emerging as a promising intervention in orthognathic surgery. Recent studies have explored its potential to minimize intraoperative and postoperative complications in these procedures.This review provides a comprehensive analysis of TXA application in orthognathic surgery, evaluating its efficacy and clinical outcomes. Methods: This umbrella review synthesized data from existing systematic reviews and meta-analyses investigating the use of TXA in orthognathic surgery. A comprehensive search was conducted across PubMed/Medline, Embase, Web of Science, and Scopus databases in February 2025, covering studies published from database inception to February 28, 2025. Data extraction followed a standardized protocol, and the methodological quality of the included reviews was evaluated using the AMSTAR-2 tool. This umbrella review was conducted and reported in accordance with the PRIOR (Preferred Reporting Items for Overviews of Reviews) guidelines. Results: Our study included eight systematic reviews and meta-analyses examining the effects of TXA in orthognathic surgery. All reviews found that TXA significantly reduces intraoperative blood loss, with mean reductions ranging from approximately 94 mL to 265 mL, regardless of the administration route. Additionally, TXA was consistently associated with higher postoperative hemoglobin levels compared to control. However, its effects on hematocrit levels, surgical duration, and hospital stay were less consistent across the studies. Importantly, none of the reviews included reported any serious adverse events related to TXA use. Conclusions: The evidence demonstrates that TXA is effective in reducing both intraoperative blood loss and postoperative hemoglobin decline, along with other clinical outcomes in orthognathic surgery. However, to definitively establish its role in clinical practice across different outcomes, future studies should employ standardized protocols for outcome assessment. Level of Evidence: Not ratable.