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Local Application of Tranexamic Acid in Plastic Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract

Background

According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss.

Objectives

To comprehensively assess the use of local TXA during plastic surgery through a systematic review and meta-analysis of randomized controlled trials addressing these issues.

Methods

Four electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, were searched until December 12, 2022. Following meta-analyses, the mean difference (MD) or standardized mean difference (SMD) for blood loss volume (BLV), ΔHct, ΔHb and operation time were calculated when appropriate.

Results

Eleven randomized controlled trials were included in the qualitative synthesis, while 8 studies were included in the meta-analysis. Compared with the control group, the local TXA group showed a reduction in blood loss volume of -1.05 (p < 0.00001; 95% CI, −1.72 to −0.38). However, local TXA had a limited effect on reducing ΔHct, ΔHb and operation time. A meta-analysis was not performed because of heterogeneity in other outcomes; however, except for 1 study in which no significant difference was observed on POD 1, all studies showed significantly lower rates of postoperative ecchymosis after surgery, 2 studies showed statistically significant reductions in transfusion risk or volume, and 3 studies reported significantly better surgical field quality in operations with local TXA. In the 2 included studies, the researchers concluded that local treatment does not play a role in relieving postoperative pain.

Conclusions

Local TXA is associated with less blood loss, less ecchymosis and better surgical field in plastic surgery patients.

Level of Evidence I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Acknowledgement

The authors declare that they have no conflict of interest.

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  1. Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. Bada Road, Shijingshan District, Beijing, 100144, China

    Senmao Wang, Jingwen Yang & Lin Lin

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Wang, S., Yang, J. & Lin, L. Local Application of Tranexamic Acid in Plastic Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesth Plast Surg 47, 1633–1643 (2023). https://doi.org/10.1007/s00266-023-03281-7

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