The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial

Abstract

Background: Tranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use.

Objectives: A comparative study examining the combined effect of IV and local TXA was conducted.

Methods: A randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate.

Results: Ratios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference (P = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis.

Conclusions: The combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively.

Figure 1.

Example of decantation in drain bottles for a 46-year-old female patient, patient A. On the left bottle, the lipoaspirate is from the right breast, where a combination of tranexamic acid (TXA) 0.5 g (in 5 mL) associated with epinephrine 1:100,000 per liter of normal saline was used for infiltration. On the right side, the lipoaspirate in the bottle is from the left breast where a solution containing epinephrine 1:100,000 per liter of normal saline was used. The patient had 0.5 g (in 5 mL) of TXA on induction intravenously. We note that the ratio of decanted volume to total lipoaspirate is 20:300 on the right and 50:300 on the left breast.

Figure 2.

Example of decantation in drain bottles for a 40-year-old female patient, patient B. On the left bottle, the lipoaspirate is from the right breast where a combination of tranexamic acid (TXA) 0.5 g (in 5 mL) associated with epinephrine 1:100,000 per liter of normal saline was used for infiltration. The right-side bottle represents lipoaspirate from the left breast where a solution containing epinephrine 1:100,000 per liter of normal saline was used. The patient had 0.5 g (in 5 mL) of TXA on induction intravenously. We note that the ratio of decanted volume to total lipoaspirate is 50:400 on the right and 90:400 on the left breast.

Figure 3.

Assessment of dermal bleeding on a 46-year-old female patient, patient A. The operator was blinded to the infiltrate solution used for each breast; this was 1 liter normal saline with either one with 5 mL of 0.5 g/5 mL tranexamic acid (TXA) associated with epinephrine 1:100,000 or with only epinephrine 1:100,000. In this patient, the right breast was infiltrated with 300 mL of a solution of 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 in 1 L of normal saline. The left breast was infiltrated with 300 mL of a solution of epinephrine 1:100,000 in 1 L of normal saline. (A) A first photograph is taken at the start of the video just as the two large gauzes are taken off. (B) A second photograph is taken at the end of the video reflecting increasing amount of dermal bleeding on the right when compared with the left.

Figure 4.

Assessment of dermal bleeding on a 40-year-old female patient, patient B. The operator was blinded to the infiltrate solution used for each breast; this was 1 liter normal saline with either one with 5 mL of 0.5 g/5 mL tranexamic acid (TXA) associated with epinephrine 1:100,000 or with only epinephrine 1:100,000. In this patient, (A) the right breast was infiltrated with 300 mL of a solution of 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 in 1 L of normal saline. (B) The left breast was infiltrated with 300 mL of a solution of epinephrine 1:100,000 in 1 L of normal saline. Both pictures were taken at the end of the video reflecting increasing amount of dermal bleeding on the right when compared with the left.