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The Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective
Stav Brown, MD1, Tal Brown1, Peter J. Taub, MD2, Rod J. Rohrich, MD3
1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY, 3Dallas Plastic Surgery Institute, Dallas, TX

Background: Tranexamic acid (TXA) has emerged as a promising agent for reducing perioperative bleeding and has recently gained popularity in aesthetic procedures. In addition to its antifibrinolytic effects, TXAs promising role in aesthetic procedures can be mainly attributed to its anti-inflammatory. Minimizing edema and ecchymosis may be significantly beneficial in aesthetic procedures, where postoperative edema may mask results and influence patient and surgeon perception of surgical outcome for months postoperatively. Despite its increasing popularity and promising role in plastic surgery, standardized guidelines for optimum administration of TXA have not been yet established. This study is the first to report the current practices of TXA usage in plastic and reconstructive surgery among American plastic surgeons towards the establishment of standardized guidelines for safe and effective administration.
Methods: A survey regarding their experience with TXA and TXA administration protocols including dosage and mode of administration was sent to all members of the ASPS.
Results: 502 ASPS members completed the survey (21 percent response rate). 100 percent of respondents were attending physicians. 17.8 percent routinely use TXA in plastic surgery. The main fields in which TXA is most popular are aesthetic surgery (90.6 percent) and craniofacial surgery (86.7 percent). However, 70.2 percent of respondents do not see any advantage of using TXA in the non-surgical setting. The most common procedures performed under TXA are face-lift (70.0 percent), Neck lift (62.0 percent), and rhinoplasty (50.0 percent). The most common breast procedures are breast reconstruction (50.0 percent) and breast reduction (32.3 percent). Soft tissue fillers are the most common non-surgical procedures performed under topical TXA (35.3 percent). The majority of respondents give TXA as an IV bolus (50.0 percent), and/or topically (47.0 percent). A standard dose of 1 gr (41.2 percent) is most commonly utilized for IV bolus, and the most common TXA solution concentration used for topical administration in aesthetic surgery is 3% (25.0 percent). Surgeons who routinely use TXA reported reduced blood loss, improved surgical field, and reduced postoperative ecchymosis. 95.7 percent of TXA users have never observed any TXA related complications.
Conclusion: This is the largest study to date to provide a broad view of TXAs utility of use among American plastic surgeons. 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 postoperative ecchymoses and edema, and improving patient outcomes.


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