Tranexamic Acid Injection may Reduce Postoperative Bruising in Eyelid Surgery, reveals research

Previous pilot studies indicated that waiting 15 minutes after a subcutaneous tranexamic acid injection could reduce intraoperative bleeding and postoperative bruising in eyelid surgery. However, the effects of initiating surgery immediately after the injection were previously unexplored. This study aimed to determine the outcomes of such an approach.

The study was designed as a prospective, randomized, multicenter, double-masked, controlled trial. It included patients undergoing bilateral symmetric upper and/or lower lid blepharoplasty or ptosis repair. Participants received tranexamic acid in one eyelid and a control in the other. Surgeons noted the side with more intraoperative bleeding, and two masked graders evaluated periocular ecchymosis at postoperative day 0 and postoperative week 1 (POW 1) using a 5-point scale. At POW 1, patients reported their subjective grading of bruising, indicating whether it was more pronounced on one side or similar on both sides. Data were analyzed using Wilcoxon signed-rank and sign tests.

• A total of 130 patients participated in the study. Findings revealed significantly less eyelid ecchymosis on the tranexamic side at both postoperative day 0 (p = 0.001) and POW 1 (p < 0.001).

• Specifically, the 69 levator advancement surgeries showed markedly less ecchymosis at postoperative day 0 (p < 0.001) and POW 1 (p = 0.001).

• Upper eyelid blepharoplasty, combined upper and lower lid blepharoplasty, and conjunctivomullerectomy showed trends towards significance.

• Among 68 patients who reported their grading at POW 1, 69% noted less bruising on the tranexamic side (p < 0.001).

• No significant difference in intraoperative bleeding was observed between the sides (p = 0.930).

The study demonstrated that administering subcutaneous tranexamic acid without a waiting period before eyelid surgery significantly reduces postoperative bruising. This effect was evident on both postoperative day 0 and POW 1, particularly in levator advancement surgeries. The lack of significant difference in intraoperative bleeding suggests that the immediate initiation of surgery post-injection does not increase intraoperative risks.

Administering subcutaneous tranexamic acid without a waiting period before eyelid surgery effectively reduces postoperative bruising without affecting intraoperative bleeding. These findings suggest that a higher dose of tranexamic acid can be a promising intervention to improve surgical outcomes and patient satisfaction in eyelid surgery.

Reference:

Paramo, R., Cheng, T., Malik, A., Fan, J., & Barmettler, A. (2024). Effect of tranexamic acid on intra- and postoperative bleeding in eyelid surgery: A prospective, randomized, multicenter, double-masked, control trial. Ophthalmic Plastic and Reconstructive Surgery, 40(3), 331–335. https://doi.org/10.1097/iop.0000000000002583