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Evaluating The Safety And Efficacy Of Concurrent Tranexamic Acid And Hormone Therapy In Gender-Affirming Chest Surgery
Miriam Meghnagi, MS1, Seth Noorbakhsh, MD
2, Abhiraj Saxena, MD
1, Sanjana Butala, BS
1, Colleen T. Ciccosanti, DO
1, Emily A. Van Kouwenberg, MD
1.
1Robert Wood Johnson Medical School, New Brunswick, NJ, USA,
2New Jersey Medical School, Newark, NJ, USA.
PURPOSE:Tranexamic acid (TXA) is frequently used in plastic surgery to reduce hematoma, seroma, and surgical blood loss. However, concerns for thromboembolic events have limited its use in patients receiving hormone therapy, especially estrogen.
METHODS:A retrospective review was conducted of patients undergoing chest masculinization (CM) or feminization (CF) (2018-2024). Demographics, patient-specific factors, and outcomes (VTE, hematoma, seroma, EBL, drain duration) were collected and analyzed with appropriate regression models.
RESULTS:248 cases (221 CM, 21 CF; mean age 26±9.3) were identified. Comorbidities included obesity (33.9%), massive weight loss (2.8%), and bleeding disorders (1.2%). Intraoperative TXA (1 g IV) was administered in 27% of CMs and 33% of CFs; patients with prior VTE (0.8%) or cancer (0.8%) did not receive TXA. All CF and 81% of CM patients were receiving hormone therapy (9.5% and 6.3% held preoperatively). No postoperative VTE occurred. No CF patients developed hematoma or seroma. In CMs, hematoma occurred in 13.6% with TXA vs. 10.5% without, and seroma in 1.7% vs. 3.7% without. Regression showed TXA was protective against hematoma (OR 0.19, p<.001) and seroma (OR 0.019, p<.001) despite higher EBL (30.1 vs 22.9 mL, p<.001) and no difference in drain duration (8.7 vs 7.6 days, p=.07).
CONCLUSION:TXA was safely used in patients receiving hormone therapy without thromboembolic events and was associated with reduced hematoma and seroma in CM patients. Higher EBL likely reflects selection bias toward patients with greater anticipated or intraoperative bleeding. Larger studies are warranted to further support TXA safety in those receiving estrogen.
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