Comparison of Tranexamic Acid Administration Methods in Rhytidectomy: A Prospective, Randomized, Double-blind Study

Tranexamic acid (TXA) is an antifibrinolytic agent with promising benefits in facial rejuvenation surgery. The best way to administer this medication for therapeutic value is currently unknown. This study compared outcomes for facelift patients given TXA intravenously versus locally in tumescent solution.

Sixty rhytidectomy patients were randomized to receive 1 g of TXA intravenously or 150 mg of TXA in facial tumescent. Blood loss and surgeon-assigned bleeding rate were recorded intraoperatively for each side of the face. On postoperative day 7, patients assessed surgical satisfaction and bruising and swelling levels, and the surgeon graded ecchymosis and edema. Time to drain removal and complication incidence were also documented.

Mean blood loss was 25.86 mL for intravenous (IV) TXA patients versus 30.00 mL for local patients (P = 0.23) on side 1. On side 2, average blood loss was 30.00 mL in the IV group and 35.54 mL in the local group (P = 0.51). The median bruising and swelling rating was 2 for IV patients and 3 for local patients (P = 0.14). The groups had equivalent median blood loss scores, satisfaction ratings, ecchymosis and edema ratings, and complication rates. Mean days to drain removal were lower in the IV TXA group (1.16 versus 2.04 d, P = 0.04). The local TXA group had significantly more variation in patient satisfaction (P = 0.04) and time to drain removal (P < 0.001).

IV administration of TXA may have a slight advantage over local infiltration as it decreases days to drain removal and yields more precise outcomes for patient satisfaction and time to drain removal.