I keep saying TXA is a gamechanger. Since it became more widely discussed in plastic surgery circles in the past year or two, the research in it has been growing.
This is a study out of Britain, “The Role of Tranexamic Acid in Anesthetic Plastic Surgery: A Survey of theBritish Association of Aesthetic Plastic Surgeons,” in Feb 2021 Aesthetic Surgery Journal.
I will keep this blog brief, as it repeats many of my other blogs. They did a survey of current practice of all the British Aesthetic Plastic Surgery members.
Findings?
- It is widely used.
- It is most frequently used in tummy tucks, breast reductions, breast lifts, facelifts, breast augmentation, and body contouring. It is less likely used in Eyelid surgery, browlift, and liposuction.
- The reported benefit was
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- Reduced postop blood loss 60%
- Reduced introp blood loss 52%
- Reduced bruising 45%
- Improved surgical field 25%
- REduced post op swelling, pain, and seroma 8%
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- 76% used IV only, usually giving 1 g IV at the start of the procedure. 14% used it IV and topically.
Discussion:
They state that TXA reduced periooperative bleeding by out 1/3. In aesthetic surgery, blood transfusions are rare, but lowering blood loss still has benefits. The National Institute of Clinical Excellence guidline for TXA is to give it to adults and children undergoing surgery who are expected to have at least moderate blood loss. They discuss there is an unsubstantiated fear of complications of blood clots. The topical use of TXA is also set to rise because it provides the benefits of utilization locally without much systemic effect.
My thoughts?
I am already using it topically, and my own experience echoes those of the surgeons above. I think the next step is to start using it IV as well. The less blood loss, the faster you heal, and the less pain and bruising you have. As long as it is safe, which all of these studies seem to indicate, it seems like the thing to do.
Their concluding remarks? “TXA is an inexpensive, extremely effective, and well tolerated adjunctive medication that has numerous patients and surgeon benefits.”