Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Zilinsky, Isaac; Barazani, Tami Brutman; Visentin, Denis; Ahuja, Kiran; Martinowitz, Uriel; Haik, Josef

doi:10.1097/dss.0000000000001786

Cited by 43 publications

(45 citation statements)

References 29 publications

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“…We need to mention that, besides the fibrin, other agents used in the formulation may contribute to the haemostatic effect of our NFAH. Tranexamic acid is a procoagulant drug that has an antifibrinolytic action and has been successfully used to reduce blood loss in several types of surgery (Meng, Pan, Xiong, & Liu, ; Queiroz et al, ; Suh, Kyung, Han, Cheong, & Lee, ; Zilinsky et al, ). Indeed, it has been shown that the use of tranexamic acid and fibrinogen reduces blood loss and improves coagulation measurements in a porcine model of liver injury (Zentai et al, ).…”

Section: Discussionmentioning

confidence: 97%

Nanostructured fibrin agarose hydrogel as a novel haemostatic agent

Campos‐Cuerva

Fernández‐Muñoz

Lopez

et al. 2019

J Tissue Eng Regen Med

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Blood loss remains a major concern during surgery and can increase the morbidity of the intervention. The use of topical haemostatic agents to overcome this issue therefore becomes necessary. Fibrin sealants are promising haemostatic agents due to their capacity to promote coagulation, but their effectiveness and applicability need to be improved. We have compared the haemostatic efficacy of a novel nanostructured fibrin‐agarose hydrogel patch, with (c‐NFAH) or without cells (a‐NFAH), against two commercially available haemostatic agents in a rat model of hepatic resection. Hepatic resections were performed by making short or long incisions (mild or severe model, respectively), and haemostatic agents were applied to evaluate time to haemostasis, presence of haematoma, post‐operative adhesions to adjacent tissues, and inflammation factors. We found a significantly higher haemostatic success rate (time to haemostasis) with a‐NFAH than with other commercial haemostatic agents. Furthermore, other relevant outcomes investigated were also improved in the a‐NFAH group, including no presence of haematoma, lower adhesions, and lower grades of haemorrhage, inflammation, and necrosis in histological analysis. Overall, these findings identify a‐NFAH as a promising haemostatic agent in liver resection and likely in a range of surgical procedures.

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Section: Discussionmentioning

confidence: 97%

Nanostructured fibrin agarose hydrogel as a novel haemostatic agent

Campos‐Cuerva

Fernández‐Muñoz

Lopez

et al. 2019

J Tissue Eng Regen Med

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“…A recent double‐blind placebo‐controlled trial in 131 patients suggested that intradermal injections of TA 100 mg/mL prior to dermatological surgery reduced bleeding, as assessed by the ratio of surgical wound size to bloodstain. Haemostasis was found to be subjectively enhanced in the TA group also ( P = 0.043), especially those on anticoagulant medications ( P = 0.01) …”

Section: Reduction Of Bleedingmentioning

confidence: 96%

The emerging importance of tranexamic acid in dermatology

2019

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Tranexamic acid (TA) is an antifibrinolytic agent, increasingly recognized as being of utility for a wide variety of skin diseases. We review the evidence supporting the use of TA for a range of dermatological indications, including (among others) melasma, postinflammatory hyperpigmentation, urticaria, angio-oedema and haemostasis, in addition to practical considerations of its use by dermatologists.

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“…Tranexamic acid is the most popular anti-fibrinolytic used in aesthetic surgery [48]. In our review, 23 studies assessed the use of TXA in various aesthetic or breast-related procedures [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64]. [57,59,60], and one was a case series [52].…”

Section: Aesthetic Surgery/breast Surgerymentioning

confidence: 99%

“…For topical/local administration, four studies reported topical administration either using soaked pledgets (undefined dosage) [52], soaked sponge tampons (undefined dosage) [57], or wound moistening with a 25 mg/ml TXA-saline solution [49,58]. In addition, three studies reported adding TXA to tumescent solution or local anesthetic solution [50,59,62].…”

Section: Aesthetic Surgery/breast Surgerymentioning

confidence: 99%

“…Notably, there was no significant difference between TXA and control groups regarding total surgery time, cumulative cautery time, net blood weight in surgical pads, patient-reported pain level, surgeon's assessment of hemostasis, or periocular ecchymosis size on the first postoperative day [50]. Meanwhile, Schroeder RJ et al (topical and local TXA) and Zilinsky I et al (local TXA) reported beneficial effect of mixing TXA with local anesthetic solution, resulting in decreased drain output and better subjective assessment of hemostasis, respectively [59,62]. Ors S et al reported positive outcomes in 15 cases of postoperative bleeding following a septo-rhinoplasty using 3-day packing with polyvinyl alcohol tampons soaked in adrenaline and tranexamic acid, along with a single intravenous dose of 250 mg of tranexamic acid [57].…”

Section: Aesthetic Surgery/breast Surgerymentioning

confidence: 99%

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Tranexamic acid in plastic surgery: routes of administration and dosage considerations

et al. 2021

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Background Excessive blood loss, during or after surgery, remains a major surgical concern despite the continuous improvement of surgical standards. Tranexamic acid (TXA), an anti-fibrinolytic, is a potential agent that has been used in a variety of methods to mitigate blood loss. In addition, TXA shows additional anti-inflammatory effects which may be of particular interest. The objective of this study is to review clinical studies involving the use of TXA in plastic surgery related procedures. Methods We carried out a literature search of Google Scholar, PubMed, Ovid Medline, and Cochrane databases since their inception for relevant clinical studies on TXA use (dosages/routes of administration) in plastic surgery-related procedures. Results Forty-five articles were included in this review. These included studies assessing the use of TXA in craniofacial surgery (15 studies), aesthetic and breast-related surgeries (23 studies), burn care (4 studies), and microsurgery (3 studies). For each subset, study design, study sample size, surgical procedure performed, TXA route of administration, dosage, study outcomes, and adverse events were summarized and reported in a separate section. Conclusions TXA is widely studied in the field of craniofacial surgery, specifically craniosynostosis surgery. Intravenous administration of TXA is the most commonly studied route of administration. Topical formulations seem to be on the rise and the added local anti-inflammatory effects and safety profile of topical use add significant appeal. Moreover, evidence on appropriate dosage protocols is scarce. The variable approach in dosing warrants further trials to assess the clinical implications, as well as potential benefit in using TXA more efficiently in the field of plastic surgery, as a whole. Level of evidence: Not ratable

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Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Cited by 43 publications

References 29 publications

Nanostructured fibrin agarose hydrogel as a novel haemostatic agent

Nanostructured fibrin agarose hydrogel as a novel haemostatic agent

The emerging importance of tranexamic acid in dermatology

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

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