Use of Tranexamic Acid in Gender-affirming Mastectomy

Rifkin, William J.; Robinson, Isabel S.; Cripps, Courtney N.; Parker, Augustus; Laspro, Matteo; Bluebond-Langner, Rachel

doi:10.1097/01.gox.0000898584.69518.66

Cited by 1 publication

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“…This complication should serve as a reminder to physicians that care should be taken in patients with a history of VTE, with close attention paid to history taking. Furthermore, in a previous study, TXA use in patients undergoing gender-affirming mastectomy did not show an increase in risk for postoperative VTEs 18 . Overall, given the small rate of adverse events, in our cohort, TXA was safe to use in FFS.…”

Section: Discussionsupporting

confidence: 49%

“…Furthermore, in a previous study, TXA use in patients undergoing gender-affirming mastectomy did not show an increase in risk for postoperative VTEs. 18 Overall, given the small rate of adverse events, in our cohort, TXA was safe to use in FFS. Its use should follow standard practice and be recommended with consideration of other risk factors, such as previous history of VTEs.…”

Section: Discussionmentioning

confidence: 62%

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Tranexamic Acid in Facial Feminization Surgery: Quantifying a High-risk Setting With Exogenous Estrogen Supplementation

Alper

Almeida

Rivera

et al. 2023

Journal of Craniofacial Surgery

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Tranexamic acid (TXA) has been increasingly utilized in orthognathic surgery, aesthetic surgery, and craniofacial surgery. However, the risk of increasing venous thromboembolic events (VTE) must be carefully considered as TXA is a prothrombotic agent. Our study aimed to investigate the safety of TXA in the setting of facial feminization surgery. These patients are at an elevated risk for VTE at baseline given their uniform history of exogenous estrogen supplementation. A retrospective review of all patients that underwent facial feminization surgery at our medical center between December 2015 and September of 2022 was performed. Demographic information, procedure type, Caprini scores, hematoma rate, VTE rate, estimated blood loss, and operative time were all studied. Unpaired t tests were used to compare patients that received TXA and those who did not. In total, there were 79 surgeries performed during our study period. There were 33 surgeries (41.77%) that used TXA intraoperatively. Ten patients (12.65%) received anticoagulation postoperatively, 5 of whom received TXA intraoperatively. Of the 33 patients who received TXA, 30 patients remained on estrogen therapy. There was no statistically significant difference in VTE rates in patients who received TXA (n = 33, 41.77%) and those who did not (n = 46, 58.23%). Bleeding events, Caprini scores, estimated blood loss, and operative time were also not found to be significantly different between the 2 cohorts. The authors found no significant increase in VTE in facial feminization patients undergoing estrogen supplementation when intraoperative TXA was utilized. This is the first known report investigating the safety of TXA in this higher risk patient population.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 62%