Assessing current applications of tranexamic acid in reconstructive microsurgery and future direction: An 11-year meta-analysis
Research article published in Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2026)
Abstract
BACKGROUND: The use of tranexamic acid (TXA) in plastic surgery is increasing due to its anti-inflammatory properties, particularly in reducing postoperative seromas. However, its role in reconstructive microsurgery remains limited due to concerns about microvascular thrombosis and flap compromise. This study reviewed the literature on TXA use in microsurgery with a meta-analysis of clinical outcomes. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines searched PubMed, Cochrane, Embase, and Google Scholar for clinical studies published from 2013 to 2023 utilizing TXA in microsurgical procedures. Two independent reviewers assessed the studies using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Outcomes of interest included the TXA administration protocol and postoperative complications. Meta-analysis was conducted using Cochrane Review Manager, evaluating for weighted relative risk (wRR) and heterogeneity (I2) of pooled data. RESULTS: Five studies investigated TXA in microsurgery, with four using intravenous (IV) TXA and included in the meta-analysis. A total of 718 patients and 854 flaps were analyzed, with 403 flaps receiving TXA. IV TXA was used in 308 patients, and topical TXA in 36. In the IV TXA cohort, there were no differences in the incidence of complications or in the risk of flap loss (wRR, 0.63; 95% CI, 0.17-2.32; p=0.49; I2=9%), thrombosis/venous congestion of the anastomosis (wRR, 0.39; p=0.06; I2=0%), hematoma (wRR, 0.76; 95% CI, 0.21-2.75; p=0.68; I2=54%), or overall systemic venous thromboembolism (wRR, 0.17; p=0.10; I2=0%). Topical TXA to the donor site wound bed demonstrated a significant decrease in the risk of various complications (relative risk [RR], 0.52; 95% CI, 0.29-0.94; p=0.03) and a significant decrease in the duration of postoperative drains by nearly 7.5 days (p=0.022). CONCLUSION: TXA is associated with decreased donor site complications without increasing the risk of flap complications or systemic thromboembolic events in microsurgery. Additionally, TXA may demonstrate anti-inflammatory properties that promote healing. TXA is a safe and effective adjunct in reconstructive microsurgery, and a randomized controlled trial may help devise a standardized treatment protocol.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This PRISMA-guided systematic review and 11-year meta-analysis pooled clinical studies (2013-2023) on tranexamic acid (TXA) in reconstructive microsurgery, analyzing 718 patients and 854 flaps; in the intravenous-TXA cohort it found no significant change in flap loss, anastomotic thrombosis/venous congestion, hematoma, or systemic venous thromboembolism, while topical TXA at the donor site was associated with fewer complications and shorter drain duration, leading the authors to call TXA a safe adjunct that warrants a randomized trial. Its relevance to ASH is contextual within reconstructive microsurgery, the same flap-salvage setting where medicinal leeches are used for venous congestion: it addresses the competing concern of microvascular thrombosis and shows TXA did not worsen flap or thrombotic outcomes in the pooled data. Caveat: the intravenous analysis rested on only four non-randomized studies with the attendant bias risk the authors flag, the findings concern TXA rather than any leech-derived agent, and the authors themselves note a randomized controlled trial is still needed; this is summarized evidence, not definitive proof.
Citation
Assessing current applications of tranexamic acid in reconstructive microsurgery and future direction: An 11-year meta-analysis.
Bright et al. · Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2026
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026