Orthognathic surgery induced fibrinolytic shutdown is amplified by tranexamic acid

Abstract Purpose Little is known on the systemic effects of oral and maxillofacial surgery on the hemostatic balance including the biochemical effects of tranexamic acid (TXA) on fibrin clot lysis. The study aimed to investigate the effect of orthognathic surgery on fibrin lysability, fibrin structure and D-Dimer and to evaluate the effect of TXA on these fibrinolytic measures. Materials and Methods This double-blind, controlled, and randomized, placebo study included patients referred to the Department of Oral and Maxillofacial Surgery at the University Hospital of Southern Denmark - Esbjerg from August 2014 through September 2016. The patients were elective and diagnosed with maxillary or mandibular deficiency, -excess or –asymmetries. All patients underwent bimaxillary orthognathic surgery (OS) with or without maxillary segmentation or additional genioplasty. Patients were blindly randomized to treatment with TXA or placebo. The primary predictor variable was OS. The secondary predictor variable was an intravenous dose of one gram of TXA or equivalent placebo preoperatively. Blood samples were collected before surgery and five hour after initiation of surgery. The primary outcome variable was the lysability of fibrin. Fibrin structure properties and D-Dimer were secondary outcome measures. The Mann Whitney U-test was used for with-in group comparisons. The Wilcoxon Signed Rank test was used for between groups comparisons. Results The sample was composed of 96 patients, 45 received placebo and 51 received TXA. Fibrin lysability decreased following OS (p Conclusion OS is associated with fibrinolytic shutdown, and alters fibrin structure properties driving the hemostatic balance in a pro-thrombotic direction. The fibrinolytic shutdown is significantly amplified by TXA.