BACKGROUND: The objective of this systematic review and meta-analysis was to assess the effects of tranexamic acid (TXA) on bleeding and thromboembolic events in orthognathic surgery out. METHODS: Three electronic databases (PubMed, Web of Science, and Cochrane Library) were searched until 01/06/2024. RESULTS: Nine randomised controlled trials and two cohort studies were included for pooled analysis. Compared with the control group, the TXA group showed a mean reduction in intraoperative blood loss of 171.30 ml (p <
0.00001
95% CI, 197.58-145.02 ml). Systemic tranexamic acid use was associated with reduced operative time by a mean of14.5 minutes (p <
0.0001
95% CI, 20.89-8.02 mins) and reduction in the need for transfusion OR= 0.33 (p <
0.01
95% CI, 0.14-0.77). CONCLUSION: This systematic review and meta-analysis supports the prophylactic use of tranexamic acid during orthognathic surgery in reducing blood loss, operative time and the risk of needing blood transfusions without increasing risk of thromboembolic complications. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .