Evidence Based Medicine: Two Decades of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery
Rod J. Rohrich, MD1, Stav Brown, MD2, Peter J. Taub, MD3
1Dallas Plastic Surgery Institute, Dallas, TX; 2Memorial Sloan Kettering Cancer Center, New York, NY; 3Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
Tranexamic Acid (TXA), an antifibrinolytic agent, has gained increasing recognition within plastic and reconstructive surgery. This study reviews the scientific evidence regarding the use of TXA in the full range of plastic surgery within the past two decades and provides clinical recommendations regarding its safe and effective use in craniofacial surgery, facelift surgery, rhinoplasty, breast procedures, burn care and microsurgery.
A systematic review and meta-analysis were conducted following the PRISMA guidelines. Study design, procedure types, dosing regimen, time and mode of administration, outcomes and complications were recorded. Outcome data collected in the meta-analysis included blood loss, transfusion requirements, hematoma rates and venous thromboembolism (VTE) rates. The Grading of Recommendations, Assessment, Development and Evaluation criteria was used to provide evidence-based clinical recommendations.
Forty-three studies (2003-2023) describing the use of TXA in plastic surgery were included comprising a total of 4480 patients. IV TXA administration was significantly associated with reduced blood-loss (-13.71 mL/kg; moderate evidence) and transfusion requirements in craniofacial surgery (-10.27 mL/kg; CI -16.34 to -4.19; moderate evidence). TXA administration was significantly associated with a reduction in blood-loss in cosmetic surgery (-26.10 mL/kg; high certainty evidence) and burn surgery (-192.33 mL/kg; moderate certainty evidence) and hematoma rates (OR=0.31; moderate certainty evidence). Hematoma rates were significantly rediced in breast-procedures (OR=0.42; moderate certainty evidence) and facelift (OR=0.21; high certainty evidence). Blood loss reduction was also demonstrated in rhinoplasty (-17.42 mL/kg; high certainty evidence).
This is the largest study to date on the use of TXA in the full range of plastic surgery, summarizing two decades of experience. The literature highlights TXA's favorable safety profile and promising role in the fields of craniofacial surgery, face-lift surgery, rhinoplasty, breast surgery and burn care.
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