Tranexamic Acid in Liposuction: A Systematic Review of Literature and Meta-Analysis

BackgroundTranexamic acid (TXA) is increasingly employed in plastic surgery to reduce perioperative hemorrhage. This systematic review assesses TXA's impact on blood loss, bruising, and fat graft survival following liposuction.MethodsA PRISMA-compliant systematic review was conducted. PubMed, Google Scholar, and Cochrane Library were searched using relevant keywords. Adult liposuction patients, receiving "intravenous TXA", "topical TXA", or "placebo", were categorized into "treatment" or "control" groups. Randomized controlled trials, prospective or retrospective cohort studies, and case-control studies were included, while uncontrolled observational studies, systematic reviews, letters, animal studies, and conference abstracts were excluded. Data on blood loss and bruises severity were synthetized into Excel spreadsheets. Study quality was independently assessed by two reviewers. Statistical analysis was accomplished employing forest plots for Hedge's G effect sizes and standardized mean differences, I2 heterogeneity, and publication bias using Egger's regressions and trim-and-fill funnel plots.ResultsSeven studies encompassing 457 patients were analyzed. Findings suggest that intravenous and topical TXA may contribute to blood loss reduction and a potential decrease in bruises severity following liposuction. No thromboembolic or serious complications were reported, suggesting a favorable safety profile for its routine use. TXA's impact on fat graft survival remains unknown.ConclusionsThis meta-analysis suggests that TXA might be beneficial in reducing blood loss and bruising after liposuction, but the results are not definitive due to study limitations. Larger randomized controlled trials with standardized protocols of TXA administration, and better-designed measurement instruments are needed to confirm these findings.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.