Antifibrinolytic Agents in Plastic Surgery: Current Practices and Future Directions

Area of Science:

• Plastic Surgery
• Pharmacology

Background:

• Minimizing blood loss is critical in plastic and reconstructive surgery.
• Antifibrinolytic agents like tranexamic acid and ε-aminocaproic acid show potential for reducing perioperative bleeding and transfusion needs.
• Existing literature on their use in plastic surgery is limited.

Purpose of the Study:

• To systematically review and summarize the current knowledge on antifibrinolytic drug use in plastic surgery.
• To evaluate clinical outcomes and provide recommendations for tranexamic acid and ε-aminocaproic acid.

Main Methods:

• A systematic review of PubMed, Cochrane, and Google Scholar databases was performed.
• Included studies focused on antifibrinolytics in plastic surgery, abstracting data on procedure type, dosage, administration, blood loss, transfusions, and complications.

Main Results:

• Thirty-three studies involving 1823 patients were analyzed.
• Tranexamic acid was used in 1328 patients, and ε-aminocaproic acid in 495 patients.

Conclusions:

• Tranexamic acid and ε-aminocaproic acid are effective in reducing blood loss and transfusion requirements in craniofacial and orthognathic surgery with no increased adverse events.
• Intravenous administration is common, but topical use offers similar efficacy with less systemic exposure.
• These agents show promise in aesthetic surgery and burn care for improving surgical fields and reducing swelling and bruising, warranting further research.