Use of tranexamic acid as a blood-saving method in patients of liposuction and other aesthetic surgeries: a retrospective study

  • Octavio de Jesus Carrascal-Navarro Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Hernando Carrascal-Carrasquilla Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Hernan Amaris-Jimenez Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Giovanny Mera-Cruz Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Javier Augusto Soto Ortega Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Octavio Carrascal-Carrasquilla Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
  • Enrique Carlos Ramos Clason Plastic and Aesthetic Surgery, Clínica Dhara, Bogotá, Colombia
Keywords: tranexamic acid, antifibrinolytics, aesthetic surgeries, liposuction, blood-saving methods, transfusions


Introduction: Liposuction is among the most grueling procedures in esthetic plastic surgery. Despite the existing evidence of tranexamic acid (ATX) as a blood-saving method in surgeries of different surgical specialties, its use in plastic-esthetic surgery is scarce, especially in liposuction.

Goal: To determine the impact of ATX on blood loss in patients who have undergone liposuction surgical procedures.

Methods: A total of 102 patients met the inclusion requirement criteria. All of them received balanced general anesthesia. 10–15 mg/kg IV of ATX (1 g on average) was administered 20 min before surgery, and so it continued for the first 24 h of postoperatory with 500 mg/IV every 8 h. Blood count samples were taken 12–20 h postoperatory.

Results: The hematocrit showed a median of 42.6% presurgical and 33.5% postsurgical. On the other hand, the presurgical hemoglobin median was 14.2 g/Dl (Interquartile ranges [RIC]) 13.4–15) and postsurgical of 11.4 (RIC: 10.6–12.1); giving a median difference of presurgical and postsurgical hemoglobin of −2.8 (RIC: −3.6 to −2.1), the difference percentage of hemoglobin concerning the base was −19.5% (RIC: –25.0 to −14.9).

Conclusion: The use of ATX in liposuction seems to grant the same benefits in terms of bleeding reduction, hemoglobin stabilization, hematocrit, and necessity of transfusions compared with operations of other surgical specialties. The dose used in this study is adequate and safe in order to achieve these goals and is consistent with the literature. More analytic studies in the field are necessary to reinforce these hypotheses.


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  1. Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting JC, et al. Cosmetic liposuction: preoperative risk factors, major complication rates, and safety of combined procedures. Aesthet Surg J 2017; 37(6): 680–94. doi: 10.1093/asj/sjw243

  2. Plastic Surgery Statistics | Global Plastic Surgery Statistics [Internet]. ISAPS. Available from: [cited 28 November 2018].

  3. Iverson RE, Lynch DJ, American society of plastic surgeons committee on patient safety. Practice advisory on liposuction. Plast Reconstr Surg 2004; 113(5): 1478–90; discussion 1491–5. doi: 10.1097/01.PRS.0000111591.62685.F8

  4. Abdelaal MM, Aboelatta YA. Comparison of blood loss in laser lipolysis vs traditional liposuction. Aesthet Surg J 2014; 34(6): 907–12. doi: 10.1177/1090820X14536904

  5. Kaoutzanis C, Winocour J, Gupta V, Ganesh Kumar N, Sarosiek K, Wormer B, et al. Incidence and risk factors for major hematomas in aesthetic surgery: analysis of 129,007 patients. Aesthet Surg J 2017; 37(10): 1175–85. doi: 10.1093/asj/sjx062

  6. Choudry UH, Hyza P, Lane J, Petty P. The importance of preoperative hemoglobin evaluation in large volume liposuction: lessons learned from our 15-year experience. Ann Plast Surg 2008; 61(3): 230–4. doi: 10.1097/SAP.0b013e31815bf341

  7. Rosique RG, Rosique MJF, Rabelo MQ. Does Postoperative erythropoietin reduce transfusions and hemodynamic instability following liposuction, either alone or associated with abdominoplasty or mammaplasty? A comparative, prospective study of 50 consecutive patients. Aesthetic Plast Surg 2017; 41(1): 98–101. doi: 10.1007/s00266-016-0748-0

  8. Gilliss BM, Looney MR, Gropper MA. Reducing noninfectious risks of blood transfusion. Anesthesiology 2011; 115(3): 635–49. doi: 10.1097/ALN.0b013e31822a22d9

  9. Kordzadeh A, Askari A, Parsa AD, Browne T, Panayiotopoulos YP. The clinical implication of blood product transfusion on morbidity and mortality of ruptured abdominal aortic aneurysm. Clin Appl Thromb Hemost 2017; 23(6): 601–6. doi: 10.1177/1076029615624548

  10. Hogg K, Weitz JI. Blood coagulation and anticoagulant, fibrinolytic, and antiplatelet drugs. In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s: the pharmacological basis of therapeutics [Internet]. 13th ed. New York, NY: McGraw-Hill Education; 2017. Available from: [cited 6 November 2018].

  11. Ng W, Jerath A, Wąsowicz M. Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther 2015; 47(4): 339–50. doi: 10.5603/AIT.a2015.0011

  12. Watts G. Utako Okamoto. Lancet 2016; 387(10035): 2286. doi: 10.1016/S0140-6736(16)30697-3

  13. WHO | Tranexamic acid (Inclusion) [Internet]. WHO. Available from: [cited 8 November 2018].

  14. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376(9734): 23–32. doi: 10.1016/S0140-6736(10)60835-5

  15. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389(10084): 2105–16. doi: 10.1016/S0140-6736(17)30638-4

  16. Study) C-2 C (Intracranial B. Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ 2011; 343: d3795. doi: 10.1136/bmj.d3795

  17. Xiong H, Liu Y, Zeng Y, Wu Y, Shen B. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2018; 19(1): 321. doi: 10.1186/s12891-018-2181-9

  18. Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 2017; 376(2): 136–48. doi: 10.1056/NEJMoa1606424

  19. Wang G, Xie G, Jiang T, Wang Y, Wang W, Ji H, et al. Tranexamic acid reduces blood loss after off-pump coronary surgery: a prospective, randomized, double-blind, placebo-controlled study. Anesth Analg 2012; 115(2): 239–43. doi: 10.1213/ANE.0b013e3182264a11

  20. Wang D, Wang L, Wang Y, Lin X. The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy. Medicine (Baltimore) 2017; 96(23): e7072. doi: 10.1097/MD.0000000000007072

  21. Kurnik NM, Pflibsen LR, Bristol RE, Singh DJ. Tranexamic acid reduces blood loss in craniosynostosis surgery. J Craniofac Surg 2017; 28(5): 1325–9. doi: 10.1097/SCS.0000000000003731

  22. Martin DT, Gries H, Esmonde N, Diggs B, Koh J, Selden NR, et al. Implementation of a tranexamic acid protocol to reduce blood loss during cranial vault remodeling for craniosynostosis. J Craniofac Surg 2016; 27(6): 1527–31. doi: 10.1097/SCS.0000000000002835

  23. Kim K-I, Kim HJ, Kim GB, Bae SH. Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy. Orthop Traumatol Surg Res 2018; 104(7): 1003–7. doi: 10.1016/j.otsr.2018.07.019

  24. Palanisamy JV, Das S, Moon KH, Kim DH, Kim TK. Intravenous tranexamic acid reduces postoperative blood loss after high tibial osteotomy. Clin Orthop Relat Res 2018; 476(11): 2148–54. doi: 10.1097/CORR.0000000000000378

  25. Wei Z, Liu M. The effectiveness and safety of tranexamic acid in total hip or knee arthroplasty: a meta-analysis of 2720 cases. Transfus Med 2015; 25(3): 151–62. doi: 10.1111/tme.12212

  26. Farrow LS, Smith TO, Ashcroft GP, Myint PK. A systematic review of tranexamic acid in hip fracture surgery. Br J Clin Pharmacol 2016; 82(6): 1458–70. v10.1111/bcp.13079

  27. Li G, Sun T-W, Luo G, Zhang C. Efficacy of antifibrinolytic agents on surgical bleeding and transfusion requirements in spine surgery: a meta-analysis. Eur Spine J 2017; 26(1): 140–54. doi: 10.1007/s00586-016-4792-x

  28. Rohrich RJ, Cho M-J. The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg 2018; 141(2): 507–15. doi: 10.1097/PRS.0000000000003926

  29. Murphy GRF, Glass GE, Jain A. The efficacy and safety of tranexamic acid in cranio-maxillofacial and plastic surgery. J Craniofac Surg 2016; 27(2): 374–9. doi: 10.1097/SCS.0000000000002250

  30. Cansancao AL, Condé-Green A, David JA, Cansancao B, Vidigal RA. Use of tranexamic acid to reduce blood loss in liposuction. Plast Reconstr Surg 2018; 141(5): 1132–5. doi: 10.1097/PRS.0000000000004282

  31. Pilbrant A, Schannong M, Vessman J. Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 1981; 20(1): 65–72. doi: 10.1007/BF00554669

  32. Benoni G, Björkman S, Fredin H. Application of pharmacokinetic data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients. Clin Drug Invest 1995; 10(5): 280–7. doi: 10.2165/00044011-199510050-00005

  33. Lanoiselée J, Zufferey PJ, Ollier E, Hodin S, Delavenne X, PeriOpeRative Tranexamic acid in hip arthrOplasty (PORTO) study investigators. Is tranexamic acid exposure related to blood loss in hip arthroplasty? A pharmacokinetic-pharmacodynamic study. Br J Clin Pharmacol 2018; 84(2): 310–9. doi: 10.1111/bcp.13460

  34. Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia 2015; 70 Suppl 1: 50–3, e18. doi: 10.1111/anae.12910

  35. Levy JH, Koster A, Quinones QJ, Milling TJ, Key NS. Antifibrinolytic therapy and perioperative considerations. Anesthesiology 2018; 128(3): 657–70. doi: 10.1097/ALN.0000000000001997

  36. Lecker I, Wang D-S, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic acid-associated seizures: causes and treatment. Ann Neurol 2016; 79(1): 18–26. doi: 10.1002/ana.24558

  37. Lin Z, Xiaoyi Z. Tranexamic acid-associated seizures: a meta-analysis. Seizure 2016; 36: 70–3. doi: 10.1016/j.seizure.2016.02.011

  38. Ramirez RJ, Spinella PC, Bochicchio GV. Tranexamic acid update in trauma. Crit Care Clin 2017; 33(1): 85–99. doi: 10.1016/j.ccc.2016.08.004

  39. Tengborn L, Blombäck M, Berntorp E. Tranexamic acid – an old drug still going strong and making a revival. Thromb Res 2015; 135(2): 231–42. doi: 10.1016/j.thromres.2014.11.012

  40. Ross J, Al-Shahi Salman R. The frequency of thrombotic events among adults given antifibrinolytic drugs for spontaneous bleeding: systematic review and meta-analysis of observational studies and randomized trials. Curr Drug Saf 2012; 7(1): 44–54. doi: 10.2174/157488612800492744

  41. Teng Y, Feng C, Liu Y, Jin H, Gao Y, Li T. Anti-inflammatory effect of tranexamic acid against trauma-hemorrhagic shock-induced acute lung injury in rats. Exp Anim 2018; 67(3): 313–20. doi: 10.1538/expanim.17-0143

  42. Jimenez JJ, Iribarren JL, Lorente L, Rodriguez JM, Hernandez D, Nassar I, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care 2007; 11(6): R117. doi: 10.1186/cc6173

How to Cite
de Jesus Carrascal-Navarro O., Carrascal-Carrasquilla H., Amaris-Jimenez H., Mera-Cruz G., Soto Ortega J. A., Carrascal-Carrasquilla O., & Ramos Clason E. C. (2022). Use of tranexamic acid as a blood-saving method in patients of liposuction and other aesthetic surgeries: a retrospective study. Science & Art Plastic Surgery Journal, 3.
Original Research Articles