The Role of Tranexamic Acid in Plastic Surgery: Review and Technical Considerations

Jia²,

et al. 2020

Medicine

Objective: Long-segment spinal fusion surgery was associated with substantial perioperative blood loss which may increase hospitalization expenses and mortality rates. Substantial studies have reported that tranexamic acid (TXA) could reduce blood products and cost after joint arthroplasty surgery. However, there still exists controversy regarding the efficacy of TXA in long-segment spinal fusion surgery. We performed this protocol to design a randomized controlled study to evaluate the efficacy of TXA in decreasing transfusion rate of allogeneic blood products and transfusion cost in degenerative lumbar scoliosis patients. Methods: This study was carried out as a double-blinded, randomized clinical trial on patients with degenerative lumbar scoliosis who prepared for long-segment spinal fusion surgery from December 2018 to December 2019. It was authorized via the Institutional Review Committee in Southwest Medical University (ky2019225). Eighty patients were divided randomly into 2 groups (Experimental group = 40, control group = 40). The patients in the experimental group received 1000 mg of TXA mixed in 100 mL normal saline as a single dose intravenously over 20 minutes before the skin incision was made. Control group received equivalent normal saline without TXA. Primary outcomes included total blood loss, estimated intraoperative blood loss, hematocrit and hemoglobin decline, postoperative drain amount, intra-/postoperative allogeneic transfusion amount and rate, and total transfusion cost. Secondary outcomes included surgical time, thrombotic complications including deep vein thrombosis and pulmonary embolism. All the needed analyses were implemented through utilizing SPSS for Windows Version 20.0. Results: Table showed the relevant clinical outcomes between experimental group and control group. Conclusion: We hypothesized that TXA was effective and safe in reducing blood transfusion and cost in long-segment spinal fusion surgery. Trial registration: This study protocol was registered in Research Registry (researchregistry5854).

Section: Introductionmentioning

confidence: 99%

Tranexamic acid reduces blood cost in long-segment spinal fusion surgery: Retraction

Jia²,

et al. 2020

Medicine

“…Topical TXA is gaining popularity as a simple, low-cost intervention to reduce surgical bleeding 23 . The present study has shown that that limited topical exposure to TXA is well tolerated in vitro.…”

Section: Discussionmentioning

confidence: 99%

Cytotoxicity and effect on wound re‐epithelialization after topical administration of tranexamic acid

et al. 2019

BackgroundTopical administration of tranexamic acid (TXA) reduces bleeding from surgical wounds similarly to intravenous use, but with negligible risk of adverse systemic events. Topical use is expanding, but is off‐label. Surgeons lack guidelines regarding safe topical dosages and modes of administration. The effects of topical TXA on skin cells and wound healing are unknown. This study investigated whether topical TXA might be cytotoxic or affect wound re‐epithelialization.MethodsHuman keratinocytes and fibroblast cell cultures and an ex vivo human skin wound model were subjected to both short (limited) and long (chronic) exposure to various clinically relevant concentrations of TXA to mimic different modalities of topical administration. Cytotoxicity and effects on wound re‐epithelialization were evaluated.ResultsIn cell culture, toxicity from chronic exposure was associated with increasing concentration and exposure time. Limited exposure to TXA did not cause significant cytotoxicity even at high concentrations. Re‐epithelialization was completely absent in wounds chronically exposed to TXA concentrations of 25 mg/ml or above, and 50–100 mg/ml induced epidermolysis of normal epithelium, possibly by a non‐toxic mechanism. Wound re‐epithelialization was slightly delayed, but not impaired, by limited exposure to 100 mg/ml or chronic exposure to 6·25 mg/ml.ConclusionAlthough short exposure to even high concentrations of topical TXA seems well tolerated in vitro, prolonged exposure can be cytotoxic and may affect wound re‐epithelialization. Surgeons should adjust the TXA concentration to the planned mode of topical administration in clinical practice. Surgical relevanceTopical tranexamic acid (TXA) may reduce bleeding from surgical wounds similarly to intravenous administration without the risk of systemic effects. Little is known, however, regarding the adverse effects of TXA on exposed tissues.We exposed in vitro human keratinocytes and fibroblasts and an ex vivo human skin wound model to TXA at various concentrations and time intervals and found that short exposure to even high concentrations or prolonged exposure to low concentrations of TXA was well tolerated. Prolonged exposure to increasing concentrations increased keratinocyte and fibroblast toxicity, and TXA concentrations of 25 mg/ml or above completely prevented wound‐re‐epithelialization.Prolonged exposure to high concentrations of topical TXA may exert unwanted local tissue effects. This study suggests that surgeons should adjust TXA concentration to the planned mode of topical administration in clinical practice.

Plastic &Amp; Reconstructive Surgery

“…Topical application is receiving increasing attention, as it is inexpensive and simple, and may reduce bleeding from all surgical surfaces. 25 Large studies from joint replacement surgery have confirmed that topical use of tranexamic acid reduces blood loss at least as well as intravenous administration. 26–30 Studies from cardiac and thoracic surgery are fewer, smaller, and not unambiguous.…”

mentioning

confidence: 99%

Serum Concentrations and Pharmacokinetics of Tranexamic Acid after Two Means of Topical Administration in Massive Weight Loss Skin-Reducing Surgery

Ausen

Pleym

Liu

et al. 2019