From Total Definer Research Group and the Dhara Clinic; Clinica el Pinar; private practice; and Corporea Health & Aesthetics, Plenus Medical Group Merida.
Plast Reconstr Surg. 2022 Sep 1;150(3):569-577. doi: 10.1097/PRS.0000000000009434. Epub 2022 Jun 28.
Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures.
The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively).
The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day ( p = 0.0001) and the fifth postoperative day ( p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups.
Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding.
The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
术中止血应格外谨慎，因为出血是手术过程中患者安全的巨大威胁。氨甲环酸是一种赖氨酸合成衍生物，通过阻断纤溶酶原的五个赖氨酸结合位点来抑制纤维蛋白溶解并减少出血。作者比较了氨甲环酸与安慰剂作为吸脂术止血剂的疗效。
作者在 2019 年 1 月至 2020 年 2 月期间在三个整形手术中心（哥伦比亚和墨西哥）计划进行吸脂术的患者中进行了一项多中心、双盲、随机、对照临床试验。141 名患者被随机分为三组：静脉内（1 克氨甲环酸）、皮下（1 克氨甲环酸）和安慰剂（生理盐水）。每组分配 47 名患者。有 30 名男性患者和 111 名女性患者。主要结局是评估各组之间术后出血的量。主要结局通过术后第 1 天（术前血红蛋白减去术后第 1 天的血红蛋白）和第 5 天（术前血红蛋白减去术后第 5 天的血红蛋白）的血红蛋白点损失来衡量。
作者发现，在术后第 1 天（p=0.0001）和第 5 天（p=0.001），静脉干预组的血红蛋白水平均高于其他两组。安慰剂组和皮下干预组之间的血红蛋白值无统计学差异。
静脉内使用氨甲环酸是减少吸脂术后出血的一种较好的治疗选择。
术前使用静脉内氨甲环酸不仅可以降低吸脂术后的出血率，而且在进行高清吸脂术时还可以增加吸脂量。需要进一步的研究来支持氨甲环酸在浸润液中的有效性。
临床问题/证据水平：治疗，I 级。
