The Effect of Tranexamic Acid Administration During Liposuction on Bleeding Complications and Ecchymosis: A Systematic Review

Abstract Liposuction is the most frequently performed cosmetic procedure. Tranexamic acid (TXA) has emerged as a promising blood loss reducing agent in plastic surgery, but its value in liposuction is still being studied. This systematic review investigates the safety and efficacy of TXA in reducing blood loss during liposuction procedures. A systematic review of PubMed (US National Library of Medicine, Bethesda, MD), MEDLINE (US National Library of Medicine), EMBASE (Elsevier, Amsterdam, the Netherlands), and Cochrane databases (Wiley, Hoboken, NJ) from inception to June 2023 was performed. The primary objective was to compare blood loss, hematoma rate, and ecchymosis from liposuction procedures in patients who received TXA versus those who did not. The secondary objective was to assess the incidence of TXA-related complications. A total of nine studies were included, published between 2018 and 2023 of which eight were prospective and one was retrospective. A total of 345 intervention versus 268 control arms were compared. Follow-up time ranged from 1-14 days. Mean age, and mean BMI ranged from 33 - 50 years, 23 to 30 kg/m2, respectively. Blood loss in aspirate was significantly less with TXA administration assessed by five studies (p < 0.05). Of the five studies that assessed the incidence of ecchymosis, all reported less bruising with TXA use. Among all the studies, only one found post-operative complications with five patients requiring transfusion in the control group (without TXA). The evidence provided in the literature suggests that TXA use in liposuction is safe and effective for reducing blood loss and ecchymosis with IV and local administration.