Rolle der Tranexamsäure in der Plastischen Chirurgie: eine systematische Überprüfung

Zusammenfassung

Hintergrund Blutungsereignisse in der Chirurgie stellen ein Problem dar und können zu Revisionsoperationen und Blutungsanämie führen, welche zum Teil mittels Bluttransfusionen therapiert werden müssen. Tranexamsäure ist ein antifibrinolytischer Wirkstoff, der bereits für die Prävention und Therapie von perioperativen Blutungen aus der Orthopädie, kardiovaskulären Chirurgie sowie Gynäkologie bekannt ist. In der Plastischen Chirurgie nimmt die Anwendung von Tranexamsäure an Popularität zu und wurde bereits in einzelnen Studien beschrieben.

Material und Methoden Es wurde eine Literaturrecherche mit Hilfe der Datenbank MEDLINE der National Library of Medicine (NLM) der Vereinigten Staaten durchgeführt. Dabei wurden Schlagwörter „Tranexamic acid in plastic surgery“, „intravenous tranexamic acid in plastic surgery“, „topical tranexamic acid in plastic surgery“ sowie „subcutaneous tranexamic acid in plastic surgery“ verwendet. Die Suche wurde auf den Zeitraum 2010 bis 2023 begrenzt. Die Arbeiten wurden nach Evidenzgrad, Aussagekraft und Verfügbarkeit analysiert und in 3 Gruppen für die topische, intravenöse oder subkutane Anwendung von Tranexamsäure aufgeteilt. Es wurden randomisierte kontrollierte Studien sowie nicht randomisierte pro- und retrospektive Kohortenstudien in die systematische Überprüfung inkludiert. Studien aus anderen Fachbereichen, Review Artikel, technical notes, experimentelle Studien, Briefe an den Editor, Kommentare und Case reports wurden exkludiert.

Ergebnisse Die Literaturrecherche ergab insgesamt 135 Arbeiten. Davon wurden 56 Arbeiten als relevant für die Plastische Chirurgie beurteilt. Nach weiterer Analyse wurden 41 Arbeiten anhand der oben beschriebenen Exklusionskriterien ausgeschlossen. 15 Studien wurden letztendlich in die vorliegende Arbeit inkludiert und daraus Empfehlungen für die Anwendungsmöglichkeiten wie intravenöse, topische und subkutane Applikation von Tranexamsäure, inklusive der Indikationen, Kontraindikationen und Dosierungsformeln erarbeitet.

Diskussion Die aktuelle Studienlage über die Anwendung der Tranexamsäure ist zwar limitiert, jedoch zeigen die Ergebnisse mehr Vorteile als Nachteile für die perioperative Anwendung. Die Etablierung der Anwendung von Tranexamsäure in der Plastischen Chirurgie könnte die Reduktion der perioperativen Blutung sowie das präzisere Operieren erleichtern und eine zügige Entfernung von Drainagen ermöglichen. Jedoch sind nach der Analyse von Nutzen- und Risikofaktoren weitere randomisierte Kontrollstudien für die Anwendung in der Plastischen Chirurgie erforderlich.

Abstract

Background Bleeding events in surgery are a problem and can lead to revision surgery and bleeding anaemia, which sometimes must be treated by blood transfusion. Tranexamic acid is an antifibrinolytic agent and is already known for its role in the prevention and treatment of perioperative bleeding in the fields of orthopaedics, cardiovascular surgery and gynaecology. In plastic surgery, the use of tranexamic acid is increasing in popularity and has already been described in individual studies.

Methods A literature search was performed using the database MEDLINE from the United States National Library of Medicine (NLM). The keywords “tranexamic acid in plastic surgery”, “intravenous tranexamic acid in plastic surgery”, “topical tranexamic acid in plastic surgery” and “subcutaneous tranexamic acid in plastic surgery” were used. The search was limited to the period from 2010 to 2023. The studies were analysed according to the level of evidence, validity and availability and divided into three groups for the topical, intravenous or subcutaneous application of tranexamic acid. Randomised controlled trials and non-randomised prospective and retrospective cohort studies were included in the systematic review. Studies from other disciplines, review articles, technical notes, experimental studies, letters to the editor, comments and case reports were excluded.

Results The literature search resulted in a total of 135 papers. Of these, 56 papers were assessed as relevant to plastic surgery. After further analysis, 41 papers were excluded using the exclusion criteria described above. Fifteen studies were finally included in the present work and recommendations for possible applications such as intravenous, topical and subcutaneous application of tranexamic acid, including the indications, contraindications and dosage formulas were developed.

Discussion Although the current study situation on the use of tranexamic acid is limited, the results show more advantages than disadvantages for perioperative use. Establishing the use of tranexamic acid in plastic surgery could facilitate the reduction of perioperative bleeding and lead to more precision in surgery, and it could enable a rapid removal of drains. However, following the analysis of benefit and risk factors, further randomised controlled trials are required for use in plastic surgery.

Schlüsselwörter

Tranexamsäure - Plastische Chirurgie - intravenöse Applikation - topische Applikation - subkutane Applikation

Key words

tranexamic acid - plastic surgery - intravenous application - topical application - subcutaneous application

Publication History

Received: 03 November 2022

Accepted: 28 March 2023

Article published online:
20 July 2023

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