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Impact of Intraoperative Intravenous Tranexamic Acid on Hematomas and Bleeding Events in Gender-Affirming Vaginoplasty Patients
Peter Shamamian
*1, Anya Wang
1, Subha Karim
1, Derek Chen
1, Carol Wang
1, Keisha Montalmant
1, Avra Laarakker
1, John H. Pang
2, Ann Tran
3, Bella Avanessian
3, Jess Ting
3, Elan Horesh
31Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Tenafly, NJ; 2Align Surgical Associates, San Francisco, CA; 3Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
Background: A more common and disruptive complication of gender-affirming vaginoplasty is postoperative bleeding. Interventions targeted at reducing the risk of postoperative bleeding include the use of intravenous tranexamic acid (IV-TXA). The effects of IV-TXA use in these patients has not been adequately investigated. The present study aims to evaluate the impact of intraoperative IV-TXA administration on postoperative bleeding events in a large sample of gender-affirming vaginoplasty patients.
Methods: Patients receiving gender-affirming vaginoplasty at the Mount Sinai Center for Transgender Medicine and Surgery between June 2019 and July 2023 were evaluated retrospectively. IV-TXA use, estimated blood loss, anticoagulation use, and bleeding complications were evaluated. Postoperative complications included minor hematomas, defined as hematomas requiring conservative treatment; major hematomas, defined as hematomas requiring intervention such as return to the operating room and readmission; major bleeding, defined as continuous bleeding from the surgical site requiring intervention; and readmission and reoperation related to bleeding. Statistical significance was set at p<0.05.
Results: Six hundred twenty-eight patients (628) were included in the study, 271 did not receive IV-TXA and 357 received IV-TXA. Surgeon preference alone dictated IV-TXA use. Significantly fewer patients in the IV-TXA group had a hematoma event (17.7% vs. 1.9%, p<0.001), a minor hematoma (15.5% vs. 2.5%, p<0.001), postoperative major bleeding (4.1% vs. 2.2%, p=0.008), and readmission for bleeding (5.9% vs. 1.3%, p=0.018). On multiple logistic regression analysis, TXA use was associated with a decreased odds of developing any type of hematoma (OR 0.140, 95% CI 0.071-0.277, p<0.001), a minor hematoma (OR 0.126, 95% CI 0.059-0.270, p<0.001), and postoperative bleeding (OR 0.348, 0.153-0.794, p=0.012).
Conclusion: The use of IV-TXA significantly reduces certain bleeding events in gender-affirming vaginoplasty patients, complications that can cause distress in the postoperative period.
Table 1. Multiple logistic regression for associated odds of bleeding events with TXA use. Covariates included age, race, BMI, hypertension, dyslipidemia, diabetes mellitus, cardiac disease, peripheral vascular disease, smoking, alcohol use, ASA status, and vaginoplasty type.
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