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The Use Of Tranexamic Acid In Cosmetic Plastic Surgery: Do We Really Need It?
Theodore E. Habarth-Morales, BS, 1LT, USAR1, Emily Isch, MD
1, Arturo J. Rios-Diaz, MD
2, Harrison D. Davis, BS
3, Robyn B. Broach, PhD
2, John P. Fischer, MD, MPH
2, Joesph M. Serletti, MD
2, Matthew P. Jenkins, MD
1;
1Thomas Jefferson University, Philadelphia, PA, USA,
2University of Pennsylvania, Philadelphia, PA, USA,
3Temple University, Philadelphia, PA, USA
BACKGROUND: Tranexamic acid (TXA) use during plastic surgery procedures has gained traction due to its theoretical benefit in reducing postoperative bleeding and seroma. We examined hemorrhagic and thrombotic complications following two common plastic surgery procedures, reduction mammaplasty (RM) and cosmetic abdominoplasty (CA), with and without intra-operative intravenous (IV) TXA administration.
METHODS: Patients undergoing bilateral RM and CA (2002-2023) were identified within TriNetX, an inpatient and outpatient electronic health record database from 78 health systems nationwide. The outcomes were one-year hematoma/seroma, need for drainage procedure, and venous thromboembolism (VTE). Propensity score matching controlling for confounders allowed comparison by intra/peri-operative IV TXA administration.
RESULTS: A total of 105,094 RMs and 5,089 CAs were identified, IV TXA was used in 1.75% of patients. Of these 1,434 RM and 498 CA patients were matched 1:1 and comprised the analytical cohort. The one-year rates of hematoma/seroma, drainage procedure and VTE were 5.1%, 4.2% and 1.7% for RM and 4.4%, 3.1% and <0.2% CA, respectively. Within adjusted analyses, TXA was not associated with decreased seroma or hematoma (HR 0.925 [95%CI: 0.591-1.447], P=0.732), drainage procedure (HR: 1.106 [95% CI 0.665-1.838], P=0.697), or VTE (HR: 0.712 [95%CI 0.315-1.609], P=0.412) following RM. This trend persisted for CA with no association of TXA and seroma/hematoma (HR 1.21 [95% CI 0.513-2.855], P=0.663) or VTE (HR 1.00 [95% CI: 0.41-2.45], P=1.00).
CONCLUSIONS: Intraoperative IV TXA administration during RM and CA does not appear to meaningfully lower post-operative bleeding complications or increase the risk of post-operative VTE.
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