Subcutaneous tranexamic acid in upper eyelid blepharoplasty: a prospective randomized pilot study

Area of Science:

• Ophthalmology
• Plastic Surgery
• Pharmacology

Background:

• Postoperative bruising and bleeding can delay healing after surgery.
• Locally administered agents are being investigated to mitigate surgical bleeding.
• Eyelid blepharoplasty is a common cosmetic procedure where bleeding and bruising can be concerns.

Purpose of the Study:

• To evaluate the efficacy of preoperative subcutaneous tranexamic acid (TXA) injection in reducing intraoperative and postoperative bleeding and ecchymoses.
• To assess the impact of TXA on healing time and patient-reported outcomes in upper eyelid blepharoplasty.

Main Methods:

• A prospective, randomized, double-blind, controlled study was conducted with 34 patients undergoing upper eyelid blepharoplasty.
• Patients received either TXA or normal saline mixed with lidocaine via subcutaneous injection before surgery.
• Outcomes measured included surgical time, cautery use, blood loss, bleeding assessment, pain, ecchymosis, and return to daily activities.

Main Results:

• A trend towards reduced ecchymoses was observed in the TXA group by postoperative day seven (p=0.072).
• No significant differences were found between TXA and placebo groups in surgical time, cautery use, blood loss, pain, or immediate postoperative ecchymosis.
• Surgeon's assessment of hemostasis also showed no significant difference between groups.

Conclusions:

• Preoperative subcutaneous tranexamic acid demonstrated no significant benefit in reducing intra- or postoperative bleeding or ecchymoses in this study population.
• The role of TXA in patients who do not discontinue antiplatelet therapy before surgery requires further investigation.