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Can Tranexamic Acid Control Bleeding during and After Total Thyroidectomy? A Randomized Double-blind Clinical Trial Study

Introduction: Head and neck operations are among the thyroid surgeries which are occasionally accompanied by blood loss (BL) during operation, tainting the operating field, and increasing the probability of damage to adjacent structures. Several studies have hitherto been conducted toward decreasing the BL that occurs during and after the operation. This study has been designed and executed with the objective of determining and comparing the effectiveness of tranexamic acid (TA) medication on controlling BL during and after total thyroidectomy. Materials and Methods: This study was carried out as a double-blind clinical trial on 83 patients affected with benign and malignant pathologies which were candidates for total thyroidectomy surgical operation, referred to the surgery department of Shahid Rahnemoun Hospital in Yazd, Iran, during a 1-year period. Patients were randomly divided into two groups including TA recipients, for which 20 mg/kg of TA was diluted to 20 cc with normal saline before surgery, and the control group which did not receive TA. The amount of BL during surgery was measured based on the blood gas value at the time of operation and post-surgery BL was measured based on the amount of blood collected in the Hemovac drain. The patients’ hemoglobin was also measured and recorded before surgery and 24 h after surgery. Results: Among the 83 studied patients, 42 patients received TA, whereas the other 41 did not receive this medication. BL during surgery in the TA receiving group was significantly less than the control group (P = 0.016). Post-operation BL in the TA receiving group was also less than the control group, although the difference was not statistically significant (P = 0.5). Moreover, the decline of hemoglobin level 24 h after surgery was not significant in the TA receiving group and the control group. Conclusion: According to the results of the present study, TA significantly reduces the amount of BL during the surgical procedure of total thyroidectomy. TA also results in a non-significant reduction of post-operation BL, whereas the hemoglobin level is not affected by it.