TXA is a gamechanger. I have started using it in my irrigation during most of my cases, and I find less bruising, faster recovery, and less drain time (*I only use drains for my tummy tuck patients). In orthopedics and trauma surgery they use TXA through the IV, and they have not seen an increase in DVT or PE risk. I have not yet been so bold, so I use it in the irrigation.
This study in the February 2021, Aesthetic Surgery Journal, “Effects of Intravenous Tranexamic Acid During Rhytidectomy: A Randomized, Controlled, Double Blind Pilot Study” was super exciting for me to see. (Yes, we plastic surgeons are excited by random things, and yes, I clearly need to get out more.)
Study:
Given that TXA is an antifibrinolytic agent shown to decrease intraoperative bleeding, reduce transfusions, and improve outcomes, they wanted to do a prospective trial focused on a plastic surgery application. They chose facelifts.
- 44 patients in a private practice center.
- They did not include patients who had recent thromboembolic event, those on active hormone replacement, and one with a history of a bleeding disorder.
- Treatment group received 1g dose of TXA prior to skin incision, and the same dose 4 hours later. The control group received saline.
- The length of surgery, average blood pressure, and average heart rates were similar between the groups.
- Bleeding was rated as mild, moderate, or severe.
- Patients were evaluated after surgery for bruising and swelling. This evaluation was done by the patient themselves and by the surgeon.
Results?
- TXA group showed decreased intraoperative bleeding, but the difference was not statistically significant.
- Postop bruising and swelling ratings were lower for TXA group, including statistically significant decrease in surgeon evaluated bruising.
- No major complications occurred
My thoughts?
Well, as I stated in the beginning of this blog, I am a fan. I get it is subjective and anecdotal, but I have noticed in my tummy tuck patients that their drains can come out sooner after I started using TXA in the irrigation. After doing tummy tucks for over 20 years, when you see a palpable change, then it means something.
This study is difficult, as it is hard to quantitate how much swelling and bruising there is. These were evaluations by the doctor and patients, and as we know, people vary a lot. Some of my patients bruise and swell more than others, and I cannot predict who is whom.
But there is something real here. And as long as TXA doesn’t increase rates of blood clots, losing less blood during surgery is just better. You will feel better, you will heal better, you will bruise less, and you will be back to life faster.