Tranexamic Acid Administration in Cosmetic Surgery

Introduction to Tranexamic Acid Use

• The American Society of Plastic Surgeons recommends administering tranexamic acid (TXA) intravenously with a loading dose of 1g over 10 minutes, followed by a maintenance dose of 1g infusion over 8 hours, as this regimen provides significant patient benefits without increasing thrombotic complications 1, 2

Administration and Dosage

• The standard dosing for TXA in patients with normal renal function is 1g IV over 10 minutes before incision, with a maximum total dose not to exceed 100 mg/kg to prevent seizures 1, 2
• For patients with renal impairment, the dose should be dramatically reduced to 10 mg/kg every 48 hours maximum, due to the increased risk of neurotoxicity and seizures 5, 6

Safety and Contraindications

• The use of TXA is contraindicated in patients with active intravascular clotting, history of hypersensitivity to tranexamic acid, and recent thrombosis, with relative contraindications including atrial fibrillation and known thrombophilia 5
• TXA is 90% renally excreted, and patients with chronic kidney disease require mandatory dose reduction to minimize the risk of neurotoxicity and seizures 5, 6

Monitoring and Precautions

• It is essential to monitor patients for clinical bleeding cessation, hemoglobin trends, and signs of hypersensitivity reactions, including anaphylaxis, and to observe for dizziness and other adverse effects 5