A Systematic Review of Tranexamic Acid in Plastic Surgery: What’s New?

Abstract

Background: Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures. Methods: A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery. Results: A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis. Conclusions: The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.

Tranexamic Acid Use During Surgery Associated with Extension of Acute Perioperative Type 1 Myocardial Infarction

“…TXA inhibits fibrinolysis by attaching to the lysine-binding site of plasminogen and preventing its conversion to plasmin, thereby reducing degradation of blood clots. It can also prevent plasmin-led degradation of platelet receptors, thus preserving platelet function 11 . There is limited high-level clinical guidance as to the effects of administering TXA in patients with acute MI, given the experiences that led to the clinical withdrawal of aprotinin 1,12,13 .…”

Investigating the Effect of Tranexamic Acid on the Treatment of Subdural Hematoma: A Systematic Review Study

“…In the same vein, Lee et al performed an SR study (13 articles with a sample size of 2271 cases) and indicated that TXA could reduce continued bleeding, mortality, and urgent endoscopic intervention (35), which is consistent with the results of this study. TXA is a cheap and affordable medicine that can reduce the rate of hemorrhage and, consequently, the accessibility and need for blood, which has been shown to be effective in a variety of surgeries, including spine, obstetrics, plastic, and chest surgery (36,37).…”

Efficacy of Tranexamic Acid in Pediatric Craniofacial and Orthognathic Surgery: A Meta-Analysis

“…2 Tranexamic acid (TXA) is a synthetic amino acid that inhibits fibrinolysis. 3,4 It has been shown to reduce blood loss and the need for blood transfusion in trauma, elective total knee arthroplasty, dental extractions, spine surgery, and cardiac surgery. [5][6][7][8][9] Topical tranexamic acid has been used for treatment of postoperative bleeding in anticoagulated patients after oral and cardiac surgery.…”

“…Multiple studies have reported efficacy and safety when used preoperatively and intraoperatively in various plastic surgery procedures. 3,4 Despite a substantial rise in the use of tranexamic acid in plastic surgery procedures, there is a paucity of literature examining the effectiveness of tranexamic acid in craniofacial surgery and particularly in pediatric and orthognathic patients. 13 The purpose of this FACE 3 (1) systematic review was to review the current literature as it pertains to the effectiveness of tranexamic acid administration in pediatric craniofacial and orthognathic surgery.…”