The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial

Abstract

Background Tranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use. Objectives A comparative study examining the combined effect of IV and local TXA was conducted. Methods A randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate. Results Ratios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference (P = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis. Conclusions The combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively. Level of Evidence: 2

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

“…A few randomized controlled trials have also evaluated the efficacy of TXA in reduction mammaplasty. A study by Abboud et al 33 found efficacy for the use of combined IVand local TXA in reducing blood loss for patients undergoing reduction mammaplasty with liposuction. Two randomized controlled trials by Ausen et al 28,29 found topical TXA to be effective at reducing drain fluid production and blood loss but found no difference in postoperative pain scores or complications.…”

Rolle der Tranexamsäure in der Plastischen Chirurgie: eine systematische Überprüfung

“…Die Arbeit von Abboud et al 2020 beschreibt eine kombinierte Anwendung von Tranexamsäure intravenös und topisch bei einer Mammareduktionsplastik mit konturangleichender Liposuktion, welche in einer randomisierten doppelt-blinden Kontrollstudie untersucht wurde. Die Autoren stellten fest, dass das Blutvolumen im Aspirat sowie in den Drainagen in der Gruppe mit Tranexamsäure um 38% reduziert werden konnte 26 .…”

Tranexamic Acid Dosing in Craniosynostosis Surgery: A Systematic Review with Meta-analysis

“…Previous studies have found similar results in various procedures showing the effects of TXA in improving hemostasis. [40][41][42][43] In this study, low dose TXA demonstrates lower rates of complications and provides efficacy for hemostasis during craniosynostosis surgery. However, at this time, further research is required to reduce the uncertainty given study heterogeneity for recommendations to be provided.…”