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Trends in Tranexamic Acid Administration Amongst the International Plastic Surgery Community

Mario Samaha, MD1, Amanda Spielman, BS1, Mahmood Al Bayati, MD2, Georges Samaha, MD1, Anne-Sophie Lessard, MD, FRCSC1 and Seth R. Thaller, MD, DMD, FACS1, (1)University of Miami Miller School of Medicine, Miami, FL, (2)University of South Florida Morsani College of Medicine, Tampa, FL
Goals/Purpose: Tranexamic acid (TXA) is a widely used antifibrinolytic agent. It has become the standard of care to reduce bleeding and overall mortality in trauma surgery and postpartum hemorrhage.1,2 Use of TXA has become an area of interest in aesthetic plastic surgery to potentially reduce intraoperative bleeding and post-operative ecchymosis. The initial study to characterize the use of TXA in plastic surgery involved survey respondents from the Israeli Society of Plastic and Aesthetic Surgery which demonstrated its reported efficacy.3 Our study is the first multinational survey to examine the current practices of TXA usage among plastic surgeons in the United States and internationally.

Methods/Technique: An institutional review board and Aesthetic Society oversight committee approved an online survey which was sent to all active members of the Aesthetic Society. Survey was organized into three parts: (1) demographic data and practice profiles, (2) familiarity, perceptions, and experience with TXA in various aesthetic plastic surgery procedures, and (3) TXA administration protocols including dosage and mode of administration. Online survey was programmed using Qualtrics Research Suite (Qualtrics, Provo, UT).

Results/Complications: 256 plastic surgeons completed the survey. 244 (94%) are in private practice. 215 (84%) of respondents reside in the United States. 180 (70%) reported routine use of TXA in their practice. Of the 78 surgeons who do not use TXA in their practice, 46% selected lack of available data as their rationale. 35 (44%), 8 (9%) reported not using it secondary to other reasons. These included cost and availability. Of the respondents who use TXA routinely, 145 (80%) reported use of TXA in rhytidectomy, 99 (55%) in abdominoplasty, 81 (45%) in liposuction, and 63 (35%) in rhinoplasty. Surgeons also reported use in common breast procedures: breast reduction (49%), mastopexy (41%), and breast augmentation (29%). 70 (35.5%) of respondents administer TXA as a standard IV bolus. Other modes include topical TXA (20.3%), variable administration (27.4%), tumescent solution (13.7%), or oral TXA (3.1%). 168 (93%) who use TXA answered that TXA reduces blood loss; 146 (84%) reported less post-operative edema and ecchymosis, 135 (81%) reported improved surgical field. 113 (69%) stated faster overall recovery. Only 4 (2%) surgeons reported thrombotic events while using TXA.

Conclusion: Our data, albeit subjective, show the efficacy and well-documented safety profile of TXA use in plastic surgery. With increasing numbers of plastic surgeons administrating TXA around the globe, our study highlights the importance of establishing an international protocol for optimal TXA utilization.

REFERENCES:

  1. CRASH-2 trial collaborators. “Effects of Tranexamic Acid on Death, Vascular Occlusive Events, and Blood Transfusion in Trauma Patients with Significant Haemorrhage (CRASH-2): A Randomised, Placebo-Controlled Trial.” The Lancet, vol. 376, no. 9734, July 2010, pp. 23–32, doi:10.1016/S0140-6736(10)60835-5.
  2. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. Lancet (2017); 389(10084):2105–2116.
  3. Brown, S. (2018). Abstract: Tranexamic Acid: Current Practices and Administration Protocols in Aesthetic Plastic Surgery in Israel. Plastic and Reconstructive Surgery Global Open, 6(9 Suppl), 158-159.
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