Tranexamic Acid: Current Practices and Administration Protocols in Aesthetic Plastic Surgery
Stav Brown, B.S.1, Yoram Wolf, MD2.
1Sackler School of Medicine, Tel Aviv, Israel, 2The Israeli Society of Plastic and Aesthetic Surgery, Tel Aviv, Israel.
Background: Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a promising agent for reducing perioperative bleeding and subsequent blood transfusion without an increase in complications and adverse events. This accumulating evidence has led to its adoption by the Israeli Defense Forces Medical Corps as well as in a variety of elective procedures. Despite its great popularity among plastic surgeons in Israel, an optimal dosing regimen has not yet been described. This study presents the current practices of TXA usage in plastic and reconstructive surgery among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) towards the establishment of standardized guidelines for optimum administration.
Methods: An online survey was sent to all members of the ISPAS. The survey was organized into three general parts: (1) demographic data and practice profiles, (2) familiarity, perceptions, and experience with TXA in plastic surgery, and (3) TXA administration protocols including dosage, mode, and time of administration.
Results: 103 Israeli plastic surgeons completed the survey. 86% of respondents use TXA routinely in aesthetic surgery. The most common procedures performed under TXA are face-lift (81%), abdominoplasty (71%), rhinoplasty (55%), and liposuction (47%). The most common breast procedures are breast reduction (60%), mastopexy (51%) and breast augmentation (52%). The majority of respondents give TXA as an IV bolus after/before skin incision (68%). Other modes include a bolus followed by topical TXA (31%), a bolus followed by maintenance infusion (5%), infusion alone (18%), or topical alone (14%). Oral administration and other combination regimens were also fully reported and are described in detail. The majority of respondents use a standard IV bolus dose with the most popular dose being 1 gr (47%). The most common TXA solution concentration used for topical administration is 1 mg/ml (42%). Respondents who use TXA routinely reported reduced perioperative blood loss (54%), improved surgical field (53%) and precision (29%) and easier postoperative recovery with less ecchymosis and edema and/or faster return to social activity (75%). No thrombotic events were reported (0%). No correlation was found between respondent characteristics and the dose or mode of administration of TXA in aesthetic procedures (p>0.05).
Conclusion: This is the first study to provide a broad view of TXA's utility of use in aesthetic plastic surgery, as well as a contemporary appraisal of administration protocols. The results emphasize the efficacy and well-documented safety profile of TXA and its important role in a variety of aesthetic procedures.
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