Tel Aviv, Israel; and New York, N.Y.
From the Sackler School of Medicine at Tel Aviv University; and the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai.
Plast Reconstr Surg. 2018 Jun;141(6):937e-949e. doi: 10.1097/PRS.0000000000004421.
Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and ε-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations.
A systematic review of the PubMed, Cochrane, and Google Scholar databases was conducted for publications examining the use of antifibrinolytics in plastic surgery. Studies were abstracted for procedure type, antifibrinolytic dose, time and mode of administration, blood loss, transfusion requirements, and complications.
Thirty-three studies were deemed eligible for inclusion, comprising a total of 1823 patients undergoing plastic surgical procedures with tranexamic acid (n = 1328) and/or ε-aminocaproic acid (n = 495).
Tranexamic acid and ε-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.
预防失血是整形和重建外科的主要考虑因素。抗纤维蛋白溶解药物氨甲环酸和ε-氨基己酸已成为减少围手术期失血和输血需求的有前途的药物。然而，整形外科学文献中缺乏相关报道。作者通过回顾现有文献中的临床结果和建议，旨在总结抗纤维蛋白溶解药物在整形外科学中的应用现状。
对 PubMed、Cochrane 和 Google Scholar 数据库进行系统检索，以查找评估抗纤维蛋白溶解药物在整形手术中应用的文献。对研究的手术类型、抗纤维蛋白溶解药物剂量、使用时间和方式、失血量、输血需求和并发症进行总结。
共有 33 项研究符合纳入标准，共纳入 1823 例接受整形手术的患者，其中使用氨甲环酸（n=1328）和/或ε-氨基己酸（n=495）。
氨甲环酸和ε-氨基己酸广泛用于减少颅面和正颌外科手术中的失血量和输血需求，且不会增加不良事件风险。静脉给药最常用，但局部制剂的疗效相似，全身分布减少。由于其良好的安全性和减少失血、改善手术视野、减少水肿和瘀斑的作用，氨甲环酸在美容手术和烧伤治疗中也成为一种很有前途的药物。有必要进一步研究这些药物在烧伤治疗、美容手术和显微外科中的作用，以规范其临床应用方案。
