What is TXA?
TXA is tranexamic acid. It is a long established medicine that is antifibrinolytic. It has been around since 1962, where it was developed in Japan, as a synthetic derivative of the amino acid lysine. Lysine stops fibrinolysis, which contributes to reduce bleeding. It is used now frequently in trauma, ortho, and cardiac surgery.
How do we use it in plastic surgery?
After seeing the results in other specialties, TXA started to be used in plastic surgery. Particularly for bigger surgeries where we are creating a flap, like breast reduction and tummy tuck, it has been shown to decrease bruising, blood loss, and drain output (when used). For my litany of blogs on the subject click here. It can be used topically or via the IV.
Study: TXA effect on clots and seizures in bleeding patients
This study was given to me by the head of my anesthesia group. The study out of the Critical Care Journal was looking at TXA risk. TXA is now used frequently for surgical bleeding and has been shown to reduce death from bleeding after trauma and childbirth. But they wanted to see does it increase thrombotic events- venous blood clots, DVT, PE, acute coronary syndrome, stroke, or seizure.
Study:
- Meta analysis, looking at 234 studies, with over 100K patients
- In bleeding patients, there was no evidence that TXA increase thrombotic events, seizures, blood clots, acute coronary syndrome, or stroke
- When looking at dose, seizures were increased in patients who got more than 2 g/ day.
They conclude, the only increased risk was that of seizures, and only when “very high doses.”
Dr. Greenberg’s thoughts on TXA
I love it. I have noticed a difference in drain output in my tummy tucks. In my breast reductions and breast lifts I do not use drains, but I see less bruising. Objectively our plastic surgical studies have shown lower risks of bleeding, less bruising, less blood in liposuction aspirate, and other benefits.
And no study shows increased blood clot risk.
I liked this study as it is out of my usual medical realm. This is in critical care, the study numbers were enormous (100K patients), and it echoes TXA safety. I do not use TXA in high amounts like they may in trauma, so the seizure risk is not a factor.
Medical Citation
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
