Antifibrinolytic Agents in Plastic Surgery

Brown, Stav; Yao, Amy; Taub, Peter J.

doi:10.1097/prs.0000000000004421

Cited by 27 publications

(5 citation statements)

References 53 publications

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“…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.…”

Section: Considerations Regarding Tranexamic Acid Tissue Concentratio...mentioning

confidence: 99%

“…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…”

mentioning

confidence: 99%

“…Both systemic and topical use of tranexamic acid have already been explored in plastic surgical fields that involve skeletal structures such as rhinoplasty, craniomaxillofacial, and orthognathic surgery. [19][20][21][22] Yet, the larger bulk of plastic surgery takes place in soft tissue, and the effect of tranexamic acid according to type of tissue may be as clinically relevant as the effect in specific procedures.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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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

Ausen

Fossmark

Spigset

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Although high-bleed surgery routinely utilizes the antifibrinolytic drug tranexamic acid, most plastic surgical procedures are conducted in soft tissue with low-volume bleeding. Unease regarding possible systemic adverse effects prevents widespread systemic use, but local use of tranexamic acid is gaining popularity among plastic surgeons. Randomized controlled trials on topical use of tranexamic acid are mainly from high-bleed surgeries, and few studies address the effect in soft tissue. This article reviews the scientific evidence regarding local use of tranexamic acid in soft-tissue surgery, discusses pharmacological effects and possible adverse reactions, and presents recommendations for use in plastic surgery. Methods: A systematic search of databases for studies on local use of tranexamic acid in soft-tissue surgery was performed. Randomized controlled trials were included for a systematic review on effect; a narrative review regarding other clinically relevant aspects is based on extensive literature searches combined with the authors’ own research. Results: Fourteen randomized controlled trials, including 1923 patients, were included in the systematic review on local use of tranexamic acid in soft-tissue surgery. Conclusions: Local use of tranexamic acid may reduce blood loss comparably to intravenous prophylactic use with negligible risk of systemic adverse effects, but high-quality randomized controlled trials are few. Prolonged exposure to high local concentrations is discouraged, and direct contact with the central nervous system may cause seizures. No single superior means of administration or dosage is supported in the literature, and lowest effective dose is unknown. There may not be one single ideal dosing regimen, but rather many possibilities adaptable for different surgical situations.

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“…8,9 It is also becoming popular in plastic surgery, especially regarding craniomaxillofacial procedures. 10,11 Although the evidence on the use of TXA in breast surgery is improving, its value still needs further investigation.…”

mentioning

confidence: 99%

Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis

Liechti,

van de Wall,

Hug

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a systematic review and meta-analysis on the results reported in the literature regarding the effect of perioperative systemic TXA administration in breast surgery. Methods: The PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases were searched for both randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio with corresponding 95% confidence interval. Results: A total of five studies encompassing 1139 patients undergoing mastectomy with or without immediate implant or free flap–based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%; OR, 0.43; 95% CI, 0.23 to 0.81) and seroma formation (11.5% versus 19.9%; OR, 0.57; 95% CI, 0.35 to 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132 mL (95% CI, 220 to 44 mL). No thromboembolic event occurred in either group. The weighted surgical-site infection rate was higher in the control group (3.1% versus 1.5%). However, these data were too sparse to perform comparative meta-analysis. Conclusion: Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery, whereas the risk for thromboembolic events and postoperative infection is not increased.

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Antifibrinolytic Agents in Plastic Surgery

Cited by 27 publications

References 53 publications

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

Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis

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