Local Pro- and Anti-Coagulation Therapy in the Plastic Surgical Patient: A Literature Review of the Evidence and Clinical Applications

Abstract

The risks of systemic anti-coagulation or its reversal are well known but accepted as necessary under certain circumstances. However, particularly in the plastic surgical patient, systemic alteration to hemostasis is often unnecessary when local therapy could provide the needed adjustments. The aim of this review was to provide a summarized overview of the clinical applications of topical anti- and pro-coagulant therapy in plastic and reconstructive surgery. While not a robust field as of yet, local tranexamic acid (TXA) has shown promise in achieving hemostasis under various circumstances, hemostats are widely used to halt bleeding, and local anticoagulants such as heparin can improve flap survival. The main challenge to the advancement of local therapy is drug delivery. However, with increasingly promising innovations underway, the field will hopefully expand to the betterment of patient care.

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

“…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.…”

Reporte de casos sobre el uso de ácido tranexámico para reducir el sangrado perioperatorio en liposucción y abdominoplastia

“…Aunque la evidencia sobre el uso de ácido tranexámico en cirugía plástica es escasa (7) importantes diferencias respecto a nuestro estudio. La principal diferencia es que la investigación de Consanção utilizó un grupo de control y un grupo experimental, lo que le permitió comparar los resultados de ambos grupos.…”

The Effect of Muscle Exercise on Perforators Flow: A Prospective Cohort Study

“…Physiologically, the arterial blood flow through a muscle is influenced by local metabolic factors [ 10 , 11 , 12 , 13 , 14 ]. During exercise, muscle metabolic activity can increase more than 60-fold and the blood flow can increase as much as 20-fold.…”