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Tranexamic Acid in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis
Evan Rothchild1, Isabelle T Smith2, Joseph A Ricci2
1Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Journal of Reconstructive Microsurgery
|June 11, 2025
Summary
Tranexamic acid (TXA) appears safe for microsurgery, not increasing clot risks. It shows potential in reducing blood loss, transfusions, and hematomas in reconstructive procedures.
Area of Science:
- Microsurgery
- Vascular Surgery
- Anesthesiology
Background:
- Tranexamic acid (TXA) is widely used to reduce blood loss in surgery.
- Its application in microsurgery is limited due to concerns about thromboembolic events and flap viability.
- This study investigates the impact of TXA in microsurgical reconstructive procedures.
Purpose of the Study:
- To determine the safety and efficacy of tranexamic acid (TXA) in microsurgical reconstruction.
- To assess the risk of thromboembolic events associated with TXA use in this context.
- To evaluate TXA's effect on perioperative blood loss and related complications.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases.
- Inclusion of retrospective/prospective cohort studies and randomized controlled trials involving TXA in microsurgery.
- Meta-analysis of pooled data on postoperative outcomes from five included studies.
Main Results:
- Five retrospective cohort studies with 718 patients were analyzed.
- TXA use was not associated with an increased risk of thromboembolic events.
- Significant reduction in mean blood loss and trends toward decreased transfusion and hematoma rates were observed with TXA.
Conclusions:
- Low-level evidence suggests TXA is safe in microsurgical reconstruction, without increasing thromboembolic risks.
- TXA may reduce perioperative blood loss, hematoma formation, and transfusion requirements.
- Higher-quality research is necessary due to study limitations and heterogeneity.
