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The Role of Tranexamic Acid in the Armamentarium of the Aesthetic Plastic Surgeon: A National Perspective
Stav Brown, BS1, Tal Brown1, Erez Dayan, MD2, Peter J. Taub, MD FACS3, Rod J. Rohrich, MD FACS2.
1Sackler School of Medicine, NY, NY, USA, 2Dallas Plastic Surgery Institute, Dallas, TX, USA, 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Hospital, NEW YORK, NY, USA.

Purpose: Tranexamic acid (TXA) has emerged as a promising agent for reducing perioperative bleeding. Despite its vast therapeutic index and favorable safety profile in other specialties, an optimal dosing regimen has not yet been described in plastic surgery. This study presents the current practices of TXA usage in plastic and reconstructive surgery among members of the American Society of Plastic Surgeons (ASPS) towards the establishment of standardized guidelines for optimum administration.
Methods: An online survey was sent to all members of the ASPS. The survey was organized into three parts: (1) practice profiles, (2) familiarity, perceptions, and experience with TXA in the full range of plastic surgery, and (3) TXA administration protocols including dosage and mode of administration in aesthetic surgery.
Results: 237 ASPS members completed the survey. 18.2 percent of respondents routinely use TXA in plastic surgery, while 82.6 percent of users utilize TXA in aesthetic surgery.
The most common procedures performed under TXA are face-lift (82.4 percent), Neck lift (71 percent), forehead and brow lift (41.2 percent), rhinoplasty (41.2 percent), abdominoplasty (41.2percent) and liposuction (35.3 percent). The most common breast procedures are breast reduction (42 percent), breast reconstruction (35.3 percent), mastopexy (29.4 percent) and breast augmentation (17.7 percent).
Soft tissue fillers, fat grafting and laser resurfacing are the most common non-surgical procedures performed under topical TXA (16.7 percent).
The majority of ASPS members give TXA as an IV bolus (52.4 percent), and/or topically (47.6 percent). A standard dose of 1 gr (38 percent) is most commonly utilized for IV bolus, however reported protocols for topical administration varied in the dosage used.
ASPS members who routinely use TXA reported reduced blood loss (57.7 percent), improved surgical field (30.8 percent) and precision (7.7 percent), and less postoperative ecchymosis (46.2 percent) and edema (19.2 percent). Improved patients satisfaction (19.2 percent) and rapid return to social activity (23 percent) were also reported following TXA administration.
96.3 percent of ASPS members have never observed complications following TXA administration.
Conclusion: This is the first study to provide a broad view of TXAs utility of use among ASPS members. The results emphasize TXAs promising role in the armamentarium of the aesthetic plastic surgeon due to its favorable safety profile and outstanding clinical benefits in minimizing perioperative blood loss, reducing edema and ecchymoses, and improving patient satisfaction and outcomes.


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