Determining the Utility of Tranexamic Acid (TXA) for the Elective Plastic Surgery Patient: A retrospective analysis of outcomes
Katherine Carruthers*1, Marla Marquez2, Matthew Smith2, Ariel Mueller2, Timothy Houle2, Katarina Ruscic2, William G. Austen1
1Surgery, Massachusetts General Hospital, Boston, MA; 2Anesthesia, Massachusetts General Hospital, Boston, MA
Postoperative bleeding episodes can be a cause of unanticipated returns to the operating room and delays in wound healing. Tranexamic acid (TXA) is an antifibrinolytic medication that has been used in the setting of trauma and to prevent post-partum hemorrhage. Studies have shown a decrease in the need for perioperative blood transfusions with no evidence of increase in thromboembolic events with utilization of TXA.
Plastic surgery has begun introducing TXA to both reconstructive and elective cases. However, there are a lack of large-scale studies analyzing the difference in the rate of postoperative hematomas in plastic surgery patients receiving TXA. The goal of this study was to perform a retrospective review of patients who underwent elective surgery and analyze the rate of hematoma requiring reoperation in patients who did and did not receive intraoperative doses of IV TXA.
Charts were reviewed to determine the cohort of patients who underwent plastic surgical procedures by a single surgeon over a five-year period. Patients were grouped based on whether they received intraoperative TXA. The number of patients from each group who experienced a postoperative hematoma requiring reoperation within 72 hours of the index surgery were noted. The percentage of cases requiring takeback was calculated and compared between groups.
388 patients underwent elective surgery with administration of intraoperative IV TXA. This cohort of patients had 0 postoperative hematomas requiring reoperation within 72 hours (0.00% takeback). 356 control patients did not receive any form of TXA at the time of surgery. Of this group, 3 patients experienced clinically significant hematomas (0.84% takeback).
In elective plastic surgery cases, postoperative hematomas are concerning since patients are expected to have uncomplicated postoperative courses and are discharged to home in the postoperative setting. Therefore, the use of medications, such as TXA, which reduce the incidence of postoperative bleeding episodes could be beneficial for these patients.
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