Abstract and Introduction
Abstract
Background: Bleeding is a potential complication of aesthetic surgery. Surgeons have adhered to the principle of minimizing blood loss. Tranexamic acid (TXA) is an antifibrinolytic medication capable of reducing bleeding. This study aimed to investigate TXA and its effect on complications and overall outcomes in aesthetic surgery patients.
Methods: This retrospective chart review of patients undergoing various aesthetic procedures between 2019 and 2022 was conducted in Riyadh, Saudi Arabia. Preoperative and postoperative hemoglobin levels, blood transfusions, and complications were the primary outcomes. Furthermore, the predictors of giving TXA were studied.
Results: In total, 435 patients were included in the study. TXA was administered to 181 patients (41.6%). Significantly higher proportions of patients who received TXA underwent trunk aesthetic surgery (P < 0.001), and those who received TXA underwent combined procedures more frequently than non-users (P < 0.001). The mean operative time and length of hospital stay were significantly longer among patients who did not receive TXA (P < 0.001, and P < 0.001, respectively). Most predictors for using TXA were significantly associated with performing liposuction (OR = 5.5), trunk aesthetic surgery (OR = 4.9), and undergoing combined procedures (OR = 2.7). No significant difference was noted in the rate of complications between the two cohorts.
Conclusions: Although our data show improvement in patient outcomes in multiple aspects, the heterogeneity of our cohort makes us unable to draw definite conclusions to recommend the use of TXA in aesthetic surgery. Thus, a randomized controlled trial is necessary to support the findings of this study.
Introduction
Aesthetic procedures have exponentially increased in the last few years. In 2020, global statistics were published by The American Society of Plastic Surgeons, showing that 15.6 million cosmetic procedures were performed around the world.[1] An important intraoperative aspect of aesthetic plastic surgery is hemostasis. An excessive amount of blood loss during an operation can lengthen operative times and increase the need for blood transfusions, both of which are associated with increased morbidity and mortality.[2] The majority of plastic surgical procedures do not result in significant blood loss. Nonetheless, bleeding may result in swelling, pain, bruising, frequent bandaging and drain changes, and the need for operations.[3] Postoperative bleeding may also lead to wound-related complications and infections, as well as the need for allogeneic blood transfusions.[4,5] Blood products can improve hemodynamic parameters and may even be a life-saving intervention in the setting of major blood loss. However, they are associated with several noninfection-related and infection-related complications, therefore raising morbidity and mortality rates.[6,7] Many interventions have proven successful in reducing surgical bleeding, including pharmacological agents such as tranexamic acid (TXA), E-aminocaproic acid, and aprotinin, all of which work by stopping fibrinolysis and enhancing clot stability.[3] TXA is a synthetic derivative of lysine. It exerts its antifibrinolytic effects by blocking lysine binding sites on plasminogen molecules, which inhibits the interaction of plasminogen with formed plasmin and fibrin. Inhibition of plasminogen activation would ultimately result in the stabilization of the preformed fibrin meshwork produced by secondary hemostasis.[8] The need for blood transfusion during major surgery has been reduced by 32%–37% after the administration of TXA intravenously.[9,10] Although TXA has been proven to have numerous advantages and benefits in cardiac,[11] orthopedic,[12] and spine surgery,[13] there is little literature on its use in aesthetic plastic surgery or body contouring other than in craniofacial[14] and facial plastic,[15] where it has been previously studied. A study on the use of TXA and its effectiveness in reducing perioperative blood loss during abdominoplasty, belt lipectomy, and body contouring surgery has not yet been conducted. Therefore, this retrospective chart review study aims to investigate the effects of TXA on complications and hematological outcomes after aesthetic surgery.
Plast Reconstr Surg Glob Open. 2023;11(9):e5229 © 2023 Lippincott Williams & Wilkins
