International survey on the use of tranexamic acid in plastic surgery—Current practices and perspectives

Background: Tranexamic acid (TXA) has gained increasing popularity in plastic and reconstructive surgery for minimizing perioperative bleeding and improving postoperative outcomes. However, standardized guidelines on its use remain lacking. Methods: An anonymous international survey was distributed to over 400 plastic surgeons worldwide to evaluate current TXA usage patterns, including dosage, timing, route of administration as well as perceived efficacy and safety. Results: Sixty-nine fully completed responses from 17 countries were analyzed. Overall, 86.9% of respondents reported TXA use, primarily to reduce blood loss and postoperative bruising. Intravenous administration was preferred by 55.9%, topical by 15.3%, and 28.8% used both. The most common intravenous dose was 10-14 mg/kg BW, usually given intraoperatively or within 30 min before incision. Topical TXA was typically applied during hemostasis or wound closure, most frequently undiluted (100 mg/mL) or in diluted solutions (10-50 mg/mL). Use was highest in aesthetic bodycontouring and breast procedures but remained low in microvascular and burn surgery. Almost all respondents (98%) reported no TXA-related complications. No thromboembolic or neurological adverse events occurred. Conclusions: TXA is widely and safely implemented in plastic surgery, particularly in aesthetic procedures, but substantial heterogeneity exists regarding dosage, timing, and route of application. These findings underscore the need for procedure-specific, evidence-based protocols and prospective multicenter trials to standardize TXA use in plastic and reconstructive surgery.