Tranexamic Acid Prevention of Hemorrhagic Complications Following Interpolated Flap Repair: A Single-Center, Retrospective, Cohort Study

Abstract

BACKGROUND Tranexamic acid (TXA) is increasingly being used to prevent hemorrhagic complications after dermatologic surgery. Interpolated flap repairs following Mohs micrographic surgery are at risk for increased bleeding events and unplanned health care utilization, particularly among patients on antithrombotic medication. OBJECTIVE To assess bleeding events after interpolated flap repair in patients receiving TXA compared with those who did not. MATERIALS AND METHODS A retrospective review identified interpolated flap repairs in a 5-year period. Hemorrhagic complications were analyzed, defined as major bleeding events, which included all unplanned medical visits, and minor bleeding events, which included any unplanned patient phone calls or messages through electronic medical record. RESULTS One hundred fifteen patients had interpolated flap repair during the 5-year period, of which 21 (18.3%) received TXA postprocedure. Twenty-seven bleeding events were identified in the non-TXA group compared with 1 event in the TXA-treated group. Patients who received TXA were less likely to have had a bleeding event (28.7% vs 4.8%, p < .01). CONCLUSION Patients undergoing interpolation flap repair were less likely to experience a bleeding event after subcutaneous injection of TXA.

Recurrent Postoperative Hemorrhage After Mohs Reconstruction in a Patient on Ruxolitinib

“…Subcutaneous TXA may also reduce bleeding complications in high-risk patients undergoing interpolated flap reconstruction for nasal defects after MMS. 5 This case report highlights the potential perioperative complications while on ruxolitinib. As the indications for JAK inhibitors increase, surgeons should exercise caution until the current preoperative guidelines are optimized.…”

“…Theoretically, TXA may increase the risk of thrombosis, though studies have not demonstrated an increase in thrombotic events 4 . Subcutaneous TXA may also reduce bleeding complications in high‐risk patients undergoing interpolated flap reconstruction for nasal defects after MMS 5 …”