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Antifibrinolytic Agents in Plastic Surgery: Current Practices and Future Directions

Brown, Stav, B.S.; Yao, Amy, B.S.; Taub, Peter J., M.D.

Plastic and Reconstructive Surgery: June 2018 - Volume 141 - Issue 6 - p 937e-949e
doi: 10.1097/PRS.0000000000004421
Plastic Surgery Focus: Special Topics
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Patient Safety CME

Background: Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and ε-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations.

Methods: A systematic review of the PubMed, Cochrane, and Google Scholar databases was conducted for publications examining the use of antifibrinolytics in plastic surgery. Studies were abstracted for procedure type, antifibrinolytic dose, time and mode of administration, blood loss, transfusion requirements, and complications.

Results: Thirty-three studies were deemed eligible for inclusion, comprising a total of 1823 patients undergoing plastic surgical procedures with tranexamic acid (n = 1328) and/or ε-aminocaproic acid (n = 495).

Conclusions: Tranexamic acid and ε-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.

Tel Aviv, Israel; and New York, N.Y.

From the Sackler School of Medicine at Tel Aviv University; and the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai.

Received for publication October 2, 2017; accepted December 6, 2017.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

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Stav Brown, B.S., Sackler School of Medicine, Tel Aviv University, 35 Klatskin Street, Tel Aviv, Israel 69978, brown.stav@gmail.com

Copyright © 2018 by the American Society of Plastic Surgeons