I started using TXA (Tranexamic Acid) in my plastic surgery practice a few years ago now. The studies show it reduces blood loss which helps healing and reduces bruising. TXA is a synthetic derivative of lysine that prevents activation of plasmin which breaks down clots. More clot stability during surgery = less bleeding. The fear of this is blood clots like DVT or PEs, but that has not been shown to happen. This has been extensively studied by many different doctor branches in orthopedics, cardiac, trauma, and OBGyne. It has been shown to reduce the probability of a blood transfusion by 1/3, and the risk of death in bleeding trauma patients and head injury deaths in traumatic brain injury.
This was a study published October 2022 in Plastic and Reconstructive Surgery Journal “A Systematic Review of Tranexamic Acid in Plastic Surgery: What’s New?”
This blog will be short as it is preaching to the choir.
This was a literature review looking at TXA use in plastic surgery – aesthetics, burn, and reconstructive.
- 233 publications
- 23 were analyzed
- Findings: “The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events.” They also state TXA is a potent anti inflammatory, so it reduces swelling and bruising which improves recovery.
Their only commentary is that we need further studies to standardize the optimal administration route (IV? topical in irrigation?) and dosage.
In diving into the review, interesting tidbits:
- Subcutaneous injection in a blepharoplasty (eyelid surgery) study where they mixed it with the local anesthetic didn’t have a statistical difference in surgery time, bleeding, recovery or bruising.
- Facelift had 3 studies. They administered it in soaked gauzes, mixed with the local anesthetic, and IV administration. Overall, they found faster surgical time due to less bleeding and lower drain output when drains were used.
- Breast surgery had 4 studies. For breast cancer with recon, there was statistical significantly less drainage and shorter hospital stay. Another study found statistical less hematomas.
- Body contouring had 1 study. TXA was given 30 minutes before surgery and after. They showed 37% less blood in the aspirate and less drop in the hematocrit. “TXA could allow aspiration of 114% more fat despite comparable hematocrit levels.”
- An interesting note: They state an off label indication for TXA is in the treatment of melasma and pigmented disorders. Mechanism is unclear, but it is thought to inhibit melanin synthesis by blocking angiogenesis and keratinocyte-melanocyte interaction.
In discussing dosing, there seems to be 80% effectiveness at 10mg/kg IV. The “standard” IV dose is 1g. With high doses of TXA there is a spectre of seizures, thought to be associated with high doses of TXA. For this reason, topical application is advocated as well, the thought being it is going to where you want it. When done topically, it is thought to reduce blood loss by 29% with no major side effects. Is there a negative to TXA in the wound? Studies seem to think not. Limited exposure to TXA does not appear to be cytotoxic.