Does Intravenous Tranexamic Acid Impact Risk of Venous Thromboembolism in Plastic & Reconstructive Surgery of the...

Tranexamic acid (TXA) is widely used in surgery to reduce perioperative bleeding, but concerns persist regarding its potential thromboembolic risks. This study evaluates the association between intraoperative intravenous (IV) TXA use and 90-day postoperative venous thromboembolism (VTE) risk in patients undergoing plastic and reconstructive surgery of the head and neck.

We conducted a retrospective cohort study using the Fortuna database, a national administrative claims dataset with over 200 million patients. Adult patients undergoing plastic and reconstructive surgery between 2010 and 2024 were identified using CPT codes, and whether they received IV TXA on the index day of procedure was determined. The primary outcome was VTE diagnosis within 90 days postoperatively. Use of enoxaparin or heparin was also documented. High-dimensional propensity score matching with inverse probability of treatment weighting (IPTW) was used to adjust for baseline demographics, comorbidities, medication exposures, and healthcare utilization. Logistic regression was used to evaluate the association between treatment and the binary outcome.

A total of 1,011 patients received IV TXA and 157,959 did not. After propensity score matching, the two groups were well-balanced. The incidence of VTE was 0.2% in the TXA group, and 0.28% in the non-TXA group. Weighted logistic regression demonstrated no statistically significant difference in VTE risk (OR 0.62, 95% CI: 0.13-3.04, p = 0.55).

IV TXA use was not associated with increased postoperative VTE risk in plastic and reconstructive surgery of the head and neck, supporting its continued use as a safe hemostatic adjunct in this patient population.