Reinhardt Myrna Eliann, Mutyala Sudeep, Gerald Mykal, Zhao Huaqing, Nova Vitalina, Araya Cambronero Sthefano, Patel Sameer, Baltodano Pablo A
Albany Medical College, Albany, NY, USA.
Fox Chase Cancer Center, Philadelphia, PA, USA.
JPRAS Open. 2023 Feb 2;40:48-58. doi: 10.1016/j.jpra.2023.01.002. eCollection 2024 Jun.
Tranexamic acid (TXA) has been used to improve bleeding outcomes in many surgical procedures. However, its blood-sparing effect in liposuction is not well established.
A systematic literature search was performed using PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, ClinicalTrials.gov, and WorldWideScience.org databases from their inception to October 8, 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors focused on 3 main topics: 1) TXA, 2) liposuction, and 3) complications. We included articles evaluating the potential blood-sparing effects of TXA in liposuction. Studies were excluded if they were systematic review articles or protocol papers, animal studies, conference abstracts, survey studies, or non-English publications.
A total of 711 articles were identified, with 1 retrospective and 4 prospective (3 randomized) studies meeting our inclusion criteria. TXA was used in various forms: administered intravenously either on induction or after the procedure, mixed into the tumescent solution, or infiltrated into the liposuction sites after lipoaspiration. A significantly smaller reduction in hematocrit was noted in the TXA group compared with that in the non-TXA group (p<0.001) despite a significantly greater amount of lipoaspirate removed in the TXA group (p<0.001). Patients in non-TXA cohorts experienced adverse effects (such as seroma and need for transfusion) that were not seen in TXA cohorts.
TXA use in patients undergoing liposuction seems to be associated with a beneficial blood-sparing effect, which may enhance safety in this population. Future studies should aim to determine the optimal route and dosing for TXA in liposuction.
Level IV.
氨甲环酸（TXA）已被用于改善多种外科手术中的出血情况。然而，其在抽脂术中的血液保护作用尚未明确。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、Embase、护理学与健康相关文献累积索引（CINAHL）、Cochrane中心、ClinicalTrials.gov和WorldWideScience.org数据库，从各数据库创建至2021年10月8日进行系统文献检索。作者关注3个主要主题：1）TXA，2）抽脂术，3）并发症。我们纳入了评估TXA在抽脂术中潜在血液保护作用的文章。如果文章为系统评价文章或方案论文、动物研究、会议摘要、调查研究或非英文出版物，则将其排除。
共识别出711篇文章，其中1篇回顾性研究和4篇前瞻性（3篇随机）研究符合我们的纳入标准。TXA有多种使用形式：诱导期或术后静脉给药、混入肿胀液中或抽脂后注入抽脂部位。尽管TXA组吸出的脂肪量明显更多（p<0.001），但与非TXA组相比，TXA组的血细胞比容降低幅度明显更小（p<0.001）。非TXA队列中的患者出现了TXA队列中未见的不良反应（如血清肿和输血需求）。
抽脂术患者使用TXA似乎具有有益的血液保护作用，这可能会提高该人群的安全性。未来的研究应旨在确定TXA在抽脂术中的最佳给药途径和剂量。
四级。
