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Tranexamic Acid for Blepharoplasty Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Matheus Pedrotti Chavez1, Filipe José Pereira2, Eric Pasqualotto3
1Department of Opthalmology, Universidade Federal de Santa Catarina.
Ophthalmic Plastic and Reconstructive Surgery
|May 7, 2025
Summary
Tranexamic acid (TXA) effectively reduces bruising and speeds recovery after blepharoplasty surgery. Intravenous TXA showed a greater benefit in reducing late-term bruising compared to subcutaneous administration.
Area of Science:
- Plastic Surgery
- Ophthalmology
- Pharmacology
Background:
- Periorbital ecchymosis and edema are common issues following blepharoplasty.
- Tranexamic acid (TXA) is an antifibrinolytic agent with potential to reduce bruising.
- Optimal administration route and efficacy of TXA in blepharoplasty require further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of intravenous (IV) or subcutaneous TXA in blepharoplasty.
- To evaluate TXA's impact on postoperative ecchymosis and recovery time.
Main Methods:
- Systematic search of PubMed, Embase, and Cochrane for relevant randomized controlled trials (RCTs).
- Primary endpoint: ecchymosis score at specific postoperative days (POD 0, 1-3, 7-9).
- Secondary outcomes: time to resume daily living, operative time, pain, and adverse events; subgroup analysis of IV vs. subcutaneous TXA.
Main Results:
- TXA significantly reduced ecchymosis scores at all measured time points (POD 0, 1-3, 7-9).
- TXA accelerated the time to resume active daily living by an average of 1.22 days.
- Intravenous TXA demonstrated a greater reduction in ecchymosis at POD 7-9 compared to subcutaneous TXA; no adverse events were reported.
Conclusions:
- TXA is a safe and effective agent for reducing ecchymosis and improving recovery after blepharoplasty.
- Intravenous administration of TXA appears more effective for late-term ecchymosis reduction.
- Further high-quality RCTs with standardized grading are recommended to confirm these findings.
