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Tranexamic Acid (TXA) In Head and Neck Microvascular Free Flap Reconstruction: A Prospective Study
Michael S. Hu, MD, MPH, MS, Fuat Baris Bengur, MD, Rula Mualla, MD, Arash Samadi, MD, Mohin Bhadkamkar, MD, Matthew Bottegal, BA, Vu T. Nguyen, MD, Michael L. Gimbel, MD, Shaum S. Sridharan, MD, Mario G. Solari, MD, Mark W. Kubik, MD
University of Pittsburgh
2023-02-10
Presenter: Michael Hu
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
There is evidence that tranexamic acid (TXA) reduces perioperative bleeding in the context of major surgery and trauma without an increase in prothrombotic events. The impact of intraoperative TXA in head and neck free flap reconstruction in unknown.
Methods:
This was a prospective study of a protocol of IV and topical TXA in major head and neck reconstruction at a major tertiary center.
Results:
A total of 99 patients undergoing head and neck free flaps were enrolled in the study. There were no adverse events related to TXA administration. Outcomes were compared to a retrospective cohort of 193 patients. Patients treated with TXA had lower estimated blood loss (202.1+/-108.6 vs 270.2+/-247.8, *p=0.001) and reduced perioperative transfusion rates (4% vs 12%, *p=0.035). There were no differences in intraoperative vessel thrombosis, flap vascular compromise, donor or recipient site complication, hematoma, pulmonary embolism (PE), or DVT between groups.
Conclusion:
Intraoperative TXA administration is safe and feasible in major head and neck reconstruction without an increase in flap failure or thrombosis. There may be an association with reduced intraoperative blood loss and perioperative transfusion requirements.
