Tranexamic Acid: Current Practices and Administration Protocols in Aesthetic Plastic Surgery in Israel

Purpose:

Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a promising agent for reducing perioperative bleeding and subsequent blood transfusion without an increase in complications and adverse events. This accumulating evidence has led to its adoption by the Israeli Defense Forces Medical Corps as well as in a variety of elective surgical procedures in various fields. Despite its great popularity among plastic surgeons in Israel, an optimal dosing regimen has not yet been described. This study presents the current practices of TXA usage in plastic and reconstructive surgery among members of the Israeli Society of Plastic and Aesthetic Surgery towards the establishment of standardized guidelines for optimum administration.

 

Methods:

An online survey was sent to all members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS). The survey was organized into three general 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, mode, and time of administration.

 

Results:

103 Israeli plastic surgeons completed the survey. 86% of respondents use TXA routinely in aesthetic surgery. The most common procedures performed under TXA are face-lift (81%), abdominoplasty (71%), rhinoplasty (55%), and liposuction (47%). The most common breast procedures are breast reduction (60%), mastopexy (51%) and breast augmentation (52%). However, 96.5% of responders report the lack of an official TXA protocol in their department or clinic. The majority of respondents give TXA as an IV bolus after/before skin incision (68%). Other modes include a bolus followed by topical TXA (31%), a bolus followed by maintenance infusion (5%), infusion alone (18%), or topical alone (14%). Oral administration and other combination regimens were also fully reported and are described in detail.

The majority of respondents use a standard IV bolus dose ranging from 0.5 gr to 10 gr, regardless of weight, with the most popular dose being 1 gr (47%). The most common TXA solution concentration used for topical administration is 1 mg/ml (42%).

Respondents who use TXA routinely reported reduced perioperative blood loss (54%), improved surgical field (53%) and precision (29%) and easier postoperative recovery with less ecchymosis and edema and/or faster return to social activity (75%) following TXA administration. No thrombotic events were reported (0%). No correlation was found between respondent characteristics and the dose or mode of administration of TXA in aesthetic procedures (p>0.05). 

 

Conclusion:

This is the first study to provide a broad view of TXA’s utility of use in aesthetic plastic surgery, as well as a contemporary appraisal of administration protocols. The results emphasize the efficacy and well-documented safety profile of TXA and its important role in a variety of aesthetic procedures, in addition to its use in craniofacial and orthognathic surgery. The authors encourage plastic surgeons to report their TXA protocols and emphasize the need for further prospective studies with a large sample size and standardized blood loss measures to establish guidelines for optimum TXA administration in different plastic and reconstructive surgery procedures.