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 minutes 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.