Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective

TXA is widely used in plastic surgery, especially in facelifts (83.6%) and rhinoplasty (55.0%), reducing bleeding (61.8%) and bruising (63.2%). Common methods include 1 g IV bolus or 3% topical solution, with 92.4% reporting no complications. Despite benefits, standardization is needed.
Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective

In this Journal Club

5-Point Summary
TXA is widely used among ASPS members, especially in aesthetic (90.3%) and craniofacial surgery (78.2%), with 92.4% reporting no complications.

4-Key Findings
TXA is common in facelifts (83.6%) and rhinoplasty (55.0%), with 61.8% reporting less bleeding and 63.2% less bruising. Popular methods include 1 g IV bolus (43.2%) and 3% topical solution (36.0%).

3-Critiques
A 21% response rate risks selection bias, potentially overrepresenting TXA users. Detailed outcomes are lacking data for specific procedures. Self-reported complications may be skewed by recall bias.

2-Practical Takeaways
TXA (1 g IV or 3% topical) reduces bleeding and bruising in facelifts and rhinoplasty. Topical TXA offers a safe, localized option for high-bleed surgeries.

1-Recommended Reading
Brown et al.’s meta-analysis (45 studies, 4,361 patients) confirms that TXA reduces blood loss in rhinoplasty and craniofacial surgery, supporting standardized protocols.

Primary Contributor: Hatan Mortada, Educational Fellow
Verified by JPRAS✅

✍️
Note from the Editor
TBC


5 Point Summary

This study explores the use of tranexamic acid (TXA) among American Society of Plastic Surgeons (ASPS) members, highlighting its widespread adoption, preferred administration methods, and safety profile in plastic surgery.


1️⃣ Hypothesis: TXA is increasingly utilized in plastic surgery with varying practices, but standardized guidelines are lacking.

2️⃣ Method: A survey of 502 ASPS members assessed TXA use across procedures, administration protocols, and perceived benefits.

3️⃣ Results: TXA is most common in aesthetic (90.3%) and craniofacial surgery (78.2%), with 92.4% reporting no complications.

4️⃣ Conclusion: TXA is effective and safe, but administration varies widely, necessitating standardized protocols.

5️⃣ Implication: Evidence supports broader TXA adoption, though further research is needed for specific procedures.

4 Key Findings

The survey reveals TXA’s prominence in specific fields, its benefits in reducing bleeding, and a reassuring safety profile.

TXA Injection: Dosage, Administration, and Clinical Use
TXA Injection: Dosage, Administration, and Clinical Use

1️⃣
Aesthetic surgery leads TXA use (90.3%), especially in facelifts (83.6%) and rhinoplasty (55.0%).

Distribution of TXA Adoption Among ASPS Members
Distribution of TXA Adoption Among ASPS Members

2️⃣
Respondents report reduced blood loss (61.8%) and bruising (63.2%), improving surgical outcomes.

TXA Advantages for Surgical and Nonsurgical Procedures Among ASPS Members
TXA Advantages for Surgical and Nonsurgical Procedures Among ASPS Members

3️⃣
IV bolus (1 g, 43.2%) and topical 3% solution (36.0%) are the most common administration methods.

TXA Advantages for Surgical and Nonsurgical Procedures Among ASPS Members
TXA Advantages for Surgical and Nonsurgical Procedures Among ASPS Members

4️⃣
Only 3.4% observed thrombotic events, with 92.4% noting no complications, suggesting a favorable safety profile.

Observed TXA-Related Complications/Side Effects
Observed TXA-Related Complications/Side Effects


3 Critiques

While comprehensive, the study has limitations in scope, depth, and generalizability.


1️⃣ Response Rate: The 21% response rate (502/2,390 members) may introduce selection bias, potentially overrepresenting TXA users.

2️⃣ Outcomes: Lack of procedure-specific outcome data limits insights into TXA’s efficacy for individual surgeries like abdominoplasty.

3️⃣ Self-reporting: Self-reported complication rates may underreport adverse events due to recall bias or reluctance to disclose.

Reported Concerns About TXA Usage
Reported Concerns About TXA Usage


2 Practical Takeaways

TXA offers actionable benefits for surgeons, particularly in aesthetic and craniofacial fields.


1️⃣ Efficacy: Surgeons can confidently use TXA (e.g., 1 g IV or 3% topical) in facelifts or rhinoplasty to reduce bleeding and bruising.

2️⃣ Safety: Topical TXA’s low systemic absorption makes it a safe option for localized effects, minimizing risks in high-bleed procedures.

Brown et al.’s meta-analysis (45 studies, 4,361 patients) confirms that TXA reduces blood loss in rhinoplasty (high certainty) and craniofacial/burn surgery (moderate certainty), urging standardized outcome measures.

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