Antifibrinolytic Agents in Plastic Surgery: Current Practices and Future Directions

Abstract

Tranexamic acid and ε-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.

Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery

“…44 A single intravenous dose of 10 to 15 mg/kg will keep plasma concentration above 10 µg/ml for 1 to 3 hours 45 and may have little risk of adverse effects, such as venous thromboembolism 3 or seizures. 46 Although much higher dosing has been practiced, particularly in cardiac but also craniomaxillofacial surgery, 19,47,48 there is little clinical support for increased effect with high dosing, 49,50 and the reports of a dose-dependent increase in seizures is changing dosing practice. 51 Tissue 44 and synovial fluid 52 tranexamic acid concentrations match those in plasma, whereas cerebrospinal fluid concentration reaches approximately 10% of plasma concentration.…”

“…Local use of tranexamic acid has been adopted by influential plastic surgeons and is receiving increasing attention. 23–27 Four published reviews on the use of tranexamic acid in plastic surgery since 2016 19,21,26,28 have, however, only identified a total of three randomized controlled trials on topical use, with two in orthognathic surgery 29,30 and only one in soft tissue (i.e., reduction mammaplasty). 31…”

“…Local use of tranexamic acid has been adopted by influential plastic surgeons and is receiving increasing attention. [23][24][25][26][27] Four published reviews on the use of tranexamic acid in plastic surgery since 2016 19,21,26,28 have, however, only identified a total of three randomized controlled trials on topical use, with two in orthognathic surgery 29,30 and only one in soft tissue (i.e., reduction mammaplasty). 31 The aim of this article is to provide insight on the pharmacological effects and adverse effects of tranexamic acid, review the current scientific evidence regarding local use in soft-tissue surgery, and present recommendations for use of tranexamic acid in plastic surgery.…”

The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates

“…Because of the potential benefits of reduced bleeding, postoperative edema, ecchymosis, and drain requirements, the role of TXA has been gradually expanding in plastic surgery 20,30,31 . Although initially introduced in craniofacial procedures, it has recently been incorporated into breast and aesthetic procedures, including reduction mammaplasty 17,18,22,29 .…”

“…Because of the potential benefits of reduced bleeding, postoperative edema, ecchymosis, and drain requirements, the role of TXA has been gradually expanding in plastic surgery. 20,30,31 Although initially introduced in craniofacial procedures, it has recently been incorporated into breast and aesthetic procedures, including reduction mammaplasty. 17,18,22,29 Reducing complications after reduction mammaplasty is not only in the interest of the plastic surgeon for immediate postoperative outcomes, but numerous studies have demonstrated that even minor complications can affect the long-term satisfaction of the patient.…”