Abstract
Background
Tranexamic acid (TXA) has gained popularity across various surgical specialties for
reducing perioperative blood loss. However, its role in microsurgery remains underexplored,
likely due to concerns that TXA may increase the risk of thromboembolic events and
compromise flap viability. Therefore, the aim of this study was to determine the impact
of TXA in microsurgical reconstructive procedures.
Methods
A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases
was conducted from their inception to September 21, 2024. Inclusion criteria were
retrospective or prospective cohort studies and randomized controlled trials that
administered TXA in the context of microsurgical reconstruction. Data on postoperative
outcomes were extracted and pooled for meta-analysis.
Results
Five retrospective cohort studies were included, with a total of 718 patients (TXA
group: 343 patients; control group: 375 patients). All studies were low-level evidence
and retrospective in design, with only one including a matched control group. There
was considerable variation across studies in both the microsurgical procedures performed
and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate
an increased risk of thromboembolic events, showed a significantly decreased mean
blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared
to the control group.
Conclusion
Our findings provide low-level evidence that TXA use in microsurgical reconstruction
does not increase the risk of thromboembolic events and may help reduce perioperative
blood loss, hematoma formation, and transfusion rates. These results offer preliminary
support for the safety of TXA in microsurgical reconstruction procedures and highlight
its potential benefits for patients at risk of bleeding complications. However, given
the limited number, heterogeneity, and low quality of available studies, these findings
should be interpreted with caution. Higher-quality research is needed to support the
routine use of TXA in microsurgery.
Keywords
tranexamic acid - TXA - microsurgery - microsurgical reconstruction - perioperative
blood loss
