Wound Healing Complications With Tranexamic Acid: Not the Silver Bullet After All

Area of Science:

• Plastic Surgery
• Wound Healing
• Pharmacology

Background:

• Tranexamic acid (TXA) is frequently used in aesthetic surgery to minimize bleeding, bruising, and edema.
• Systemic TXA carries risks like thrombosis and seizures, prompting exploration of local administration methods (topical or mixed with local anesthetic).
• Local TXA is presumed safer due to reduced systemic absorption, but potential adverse effects remain a concern.

Observation:

• This report details four cases of wound healing complications following the local administration of tranexamic acid.
• One patient received topical TXA, while three patients had TXA incorporated into their local anesthetic solution.
• These specific adverse events associated with local TXA application have not been previously documented in medical literature.

Findings:

• Locally administered tranexamic acid, whether applied topically or infiltrated with local anesthetic, was associated with wound healing complications in these four patients.
• The observed complications suggest that local TXA use, despite reduced systemic absorption, is not entirely risk-free.
• This case series introduces previously unreported adverse outcomes linked to localized TXA application in aesthetic procedures.

Implications:

• Surgeons should be aware of the potential for wound healing complications when using tranexamic acid locally in aesthetic surgery.
• The findings suggest a need for further investigation into the safety profile and optimal use of local TXA to mitigate risks.
• This case report serves as a critical warning, emphasizing the importance of careful patient selection and monitoring when employing local TXA strategies.