Tranexamic Acid in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis

Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase the risk of thromboembolic events and compromise flap viability. Therefore, the aim of this study was to determine the impact of TXA in microsurgical reconstructive procedures.A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases was conducted from their inception to September 21, 2024. Inclusion criteria were retrospective or prospective cohort studies and randomized controlled trials that administered TXA in the context of microsurgical reconstruction. Data on postoperative outcomes were extracted and pooled for meta-analysis.Five retrospective cohort studies were included, with a total of 718 patients (TXA group: 343 patients; control group: 375 patients). All studies were low-level evidence and retrospective in design, with only one including a matched control group. There was considerable variation across studies in both the microsurgical procedures performed and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate an increased risk of thromboembolic events, showed a significantly decreased mean blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared to the control group.Our findings provide low-level evidence that TXA use in microsurgical reconstruction does not increase the risk of thromboembolic events and may help reduce perioperative blood loss, hematoma formation, and transfusion rates. These results offer preliminary support for the safety of TXA in microsurgical reconstruction procedures and highlight its potential benefits for patients at risk of bleeding complications. However, given the limited number, heterogeneity, and low quality of available studies, these findings should be interpreted with caution. Higher-quality research is needed to support the routine use of TXA in microsurgery.