Effect of Local Tranexamic Acid on Hemostasis in Rhytidectomy.

Hematoma is the most common complication in rhytidectomy. Tranexamic acid (TXA) is an antifibrinolytic that may be a useful tool to reduce intraoperative bleeding and postoperative hematoma risk. To determine whether local TXA reduces intraoperative bleeding and postoperative drain output in rhytidectomy. Retrospective cohort study of patients undergoing deep plane rhytidectomy with platysmaplasty. Beginning January 1, 2019, we began adding 1 cc (100 mg) of TXA to every 10 cc of local anesthetic and tumescent solution. Patients were, therefore, separated into two cohorts: control and TXA. Primary outcomes include postoperative day 1 (POD1) drain output, days to drain removal, percentage drains removed POD1, and percentage POD1 drain output <25 cc. Secondary outcomes include minor hematoma, major hematoma, Nitro-bid use, intraoperative estimated blood loss (EBL), and thromboembolic events. POD1 drain output reduced from 50.4 cc in control group versus 14.8 cc with TXA ( < 0.001). Average day of drain removal reduced from 1.8 days in control group versus 1.2 days with TXA ( = 0.001). Percentage of drains removed on POD1 was increased from 34.4% in control group to 77.3% with TXA ( < 0.001). Percentage of POD1 drain output <25 cc was increased from 21.9% in control group to 95.5% with TXA ( < 0.001). Intraoperative EBL <50 cc increased from 25% in control group to 75% with TXA ( < 0.001). No statistically significant difference was observed between control and TXA in rates of minor hematoma, major hematoma, Nitro-bid use, or thromboembolic events. Local TXA used in rhytidectomy significantly reduces intraoperative blood loss, postoperative drain output, and time to drain removal. No significant difference was observed in postoperative complication rates.