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.
Resumen
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática guiada por PRISMA y metaanálisis de 11 años agrupó estudios clínicos (2013-2023) sobre el ácido tranexámico (TXA) en microcirugía reconstructiva, analizando 718 pacientes y 854 colgajos; en la cohorte de TXA intravenoso encontraron que no hubo un cambio significativo en la pérdida de colgajo, trombosis anastomótica/congestión venosa, hematoma o tromboembolia venosa sistémica, mientras que el TXA tópico en el sitio donante estuvo asociado con menos complicaciones y una duración más corta del drenaje, lo que llevó a los autores a considerar al TXA como un coadyuvante seguro que merece un ensayo aleatorio. Su relevancia para la ASH está contextualizada dentro de la microcirugía reconstructiva, el mismo escenario de salvamento de colgajos donde se utilizan sanguijuelas medicinales para la congestión venosa: aborda la preocupación contraria de la trombosis microvascular y muestra que el TXA no empeoró los resultados de colgajo o trombóticos en los datos agrupados. Advertencia: el análisis intravenoso se basó en solo cuatro estudios no aleatorizados con el riesgo de sesgo concomitante que señalan los autores, los hallazgos se refieren al TXA y no a ningún agente derivado de sanguijuelas, y los autores mismos señalan que aún se necesita un ensayo controlado aleatorio; esto es evidencia resumida, no una prueba definitiva.
Citación
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
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026