TRANEXAMIC ACID

Tranexamic Acid(TXA) has been shown to improve melasma treatment or help homeostatic in the past decade, but no report on improving surgical scars. Given that early intervention may enhance surgical scar outcomes, this split-scar study investigates whether immediate postoperative administration of TXA around the incision site can help prevent scar formation. In this prospective trial, 30 consecutive patients who underwent surgery from January 2022 to January 2024 were enrolled. TXA was injected randomly into half of each surgical wound closure immediately after surgery by plastic surgeons. The scars were assessed independently using the visual analogue scale (VAS) and the modified Stony Brook Scar Evaluation Scale (mSBSES) at follow-ups. The occurrence of complications or adverse events was also recorded. In total, 30 patients who completed the study were analyzed. The TXA-treated side achieved significantly improved VAS scores and better mSBSES scores (p< 0.05, respectively), which revealed a significant improvement in appearance and narrower scars. No severe complications were reported. This study demonstrates that immediate postsurgical TXA injections can improve the appearance of postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Tranexamic acid ( TXA ) is the main component of antihemorrhagic drugs but is also used as an ingredient in cosmetic formulations for its depigmenting action. The acid-base properties were investigated in aqueous solutions containing NaCl, KCl, and (CH 3 ) 4 NCl, at different ionic strengths, at T = 298.15 ± 0.15 K and only in NaCl (aq) at 283.15 ≤ T /K ≤ 318.15. The different behavior of TXA in the diverse media was explained by the formation of weak complexes with the components of the ionic media. The complexing ability of TXA toward Ca 2+ , Mg 2+ , Zn 2+ , and Sn 2+ , at T = 298.15 ± 0.15 K, was studied in NaCl (aq) in the range of 0.15 ≤ I /mol dm -3 ≤ 1.0; the modeling of the formation constants with ionic strength was performed by an extended Debye-Hückel type equation and the Specific ion Interaction Theory. For all M 2+ / TXA systems, the common M-( TXA ) species was obtained, and in the same experimental conditions, the stability trend observed is log K Sn TXA > log K Zn TXA > log K Mg TXA > log K Ca TXA . The sequestering ability of TXA toward the metals was estimated by means of pL 0.5 . To complete the picture of the chemical behavior of TXA , some simulations in blood plasma were also performed.

Postoperative hematoma requiring reoperation is a clinically significant complication in breast surgery. Although tranexamic acid (TXA) is widely used in other surgical specialties to reduce bleeding, its routine use in breast surgery remains limited due to insufficient evidence. This study aimed to evaluate whether intraoperative TXA reduces the incidence of hematoma following reduction mammaplasty. We conducted a retrospective, single-center cohort study including 656 consecutive patients who underwent reduction mammaplasty between 2019 and 2024. TXA was administered intravenously (n = 124, 43%), topically (n = 124, 43%), or via both routes (n = 39, 14%) according to surgeon preference. Patients exposed to TXA were compared with those unexposed. TXA use was associated with a significantly lower rate of postoperative hematomas requiring reoperation (2.1% vs. 5.1%; OR 2.3, 95% CI: 1.1-5.0; p = 0.042). Operative time was longer in the TXA group (133 vs. 122 minutes; p < 0.001), and patients receiving TXA had higher intraoperative blood loss and breast resection weights. No significant differences were observed in overall complications or 30-day reoperation rates, although superficial infections were more frequent in the non-TXA group (3.8% vs. 0.7%; p = 0.022). Multivariable analysis suggested a trend toward TXA as an independent protective factor. No TXA-related adverse events were reported. Intraoperative TXA in reduction mammaplasty was associated with a more than twofold reduction in postoperative hematomas. As a simple and low-risk intervention, TXA may reduce the need for reoperation. Large randomized controlled trials are warranted to confirm these findings and guide definitive clinical recommendations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hyperpigmentation disorders such as melasma require topical therapies that are both effective and well tolerated, yet many current depigmenting agents are limited by irritation or inconsistent efficacy. Tranexamic acid (TXA) is a clinically used small molecule with emerging anti-pigmentation utility, but its topical performance is often constrained by insufficient penetration and limited cellular access. In this work, we engineered a tetrahedral framework nucleic acid (tFNA)-enabled TXA formulation (tFNAs-TXA) to enhance topical delivery and anti-melanogenic activity. tFNAs-TXA was successfully constructed with preserved nanostructure, physicochemical stability, and efficient cellular internalization. Functionally, tFNAs-TXA significantly attenuated α-MSH-induced melanogenesis in B16 cells without overt cytotoxicity and downregulated the cAMP-p-CREB-MITF-TYR signaling cascade at both protein and mRNA levels. In a UVB-induced mouse model, topical tFNAs-TXA markedly reduced dorsal pigmentation and mitigated UVB-associated histopathological changes, including melanin deposition, collagen disorganization, and epidermal hyperplasia, achieving depigmenting efficacy with better gross tolerability. Together, these findings establish tFNAs-TXA as a concise, non-invasive delivery strategy that potentiates TXA for safer and more effective management of UV-related hyperpigmentation.

In patients with a hip fracture, anaemia has been associated with increased transfusion requirements, poor functional outcomes, prolonged hospital stays and increased mortality. While anaemia in elderly patients with hip fractures has traditionally been attributed to bleeding during or after surgery, many of these patients are anaemic on hospital admission. Thus, detecting and managing anaemia in the perioperative, postoperative and, most significantly, the preoperative period is important to avoid the need for blood transfusions and to improve patient outcomes. The protocol for this clinical trial is designed to evaluate the efficacy and safety of both combined intravenous and topical tranexamic acid (TXA) therapy, or topical administration alone, assessing its effect on blood loss and the need for blood transfusions in elderly patients undergoing hip fracture surgery. This is a multicentre, double-blinded, randomised, placebo-controlled trial with a 1:1 allocation ratio. Patients of both sexes, aged ≥65 years, who are admitted to the emergency department and will undergo hip fracture surgery are eligible for enrolment. Eligible patients who provide their consent will be stratified according to the type of fracture (intracapsular and extracapsular) and whether or not they are suitable for intravenous TXA therapy, and they will then be randomly allocated to receive either TXA or a placebo. The primary outcome is the blood transfusion rate from patient admission to the emergency department until discharge, while the secondary outcomes include: the preoperative, perioperative and postoperative haemoglobin and haematocrit levels; the preoperative and postoperative occult and total blood loss; the mean length of hospital stay; and any adverse events assessed for up to 1 year after patient discharge. The study was approved by the Basque Country Ethics Committee (Ref.: 2021012) and the Spanish Agency for Medicines and Healthcare Products (Agencia Española de Medicamentos y Productos Sanitarios). All participants will provide their written informed consent prior to study inclusion. The trial's results, regardless of its outcomes, will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals, and they will be made publicly available through the European Union Clinical Trials Register after the end of the clinical trial. EudraCT Number 2020-002144-23; EUCT Number 2024-519349-31-00.

Post-inflammatory hyperpigmentation and post-inflammatory erythema are common sequelae of acne, particularly affecting individuals with skin of color. Up to 85% of patients with Fitzpatrick phototypes IV-VI develop post-inflammatory hyperpigmentation following inflammatory acne lesions. Acne-induced hyperpigmentation (AIH) results from increased melanin production and deposition triggered by inflammatory mediators, while acne-induced macular erythema reflects vascular alterations. Both AIH and acne-induced macular erythema can persist for months or even years, significantly contributing to the psychosocial burden of acne and negatively impacting patients' quality of life - sometimes to a greater extent than active acne itself. Female individuals, darker skin color, severe acne, facial sites, excessive sunlight exposure, and traumatized lesions are important risk factors for AIH. Diagnosis relies on visual inspection, acne history, and skin phototype assessment. Treatment options include topical agents such as azelaic acid, retinoids, antioxidants, and hydroquinone, as well as systemic therapies such as isotretinoin, oral antibiotics, and oral tranexamic acid. Chemical peeling and energy-based devices, including lasers and microneedling, offer additional therapeutic avenues. Photoprotection is crucial in managing AIH, particularly in skin of color patients. Despite the high prevalence of AIH, there is a lack of validated patient-reported outcome measures specific to AIH/acne-induced macular erythema, highlighting the need for further research and standardized assessment tools. This article provides a practical approach, highlighting therapeutic strategies and recommendations for AIH across all skin types.

In recent times, tranexamic acid (TA) is claimed to have whitening effects especially for ultraviolet-induced hyperpigmentation including melasma. The aim of our study was to evaluate the efficacy and safety of topical solution of TA and compare it with combined solution of hydroquinone and dexamethasone as the gold standard treatment of melasma in Iranian women. This was a double-blind split-face trial of 12 weeks which was conducted in Isfahan, Iran. Fifty Iranian melasma patients applied topical solution of 3% TA on one side of the face, and topical solution of 3% hydroquinone + 0.01% dexamethasone on the other side two times a day. The Melasma Area and Severity Index (MASI) and the side effects were evaluated at baseline and every 4 weeks before and after photographs to be compared by a dermatologist were taken. The patient satisfaction was documented at week 12. A repeated measurement analysis was used to evaluate the changes in the MASI score before and after treatments. A significant decreasing trend was observed in the MASI score of both groups with no significant difference between them during the study (P < 0.05). No differences were seen in patients' and investigator's satisfaction of melasma improvement between two groups (P < 0.05). However, the side effects of hydroquinone + dexamethasone were significantly prominent compared with TA (P = 0.01). This study's results introduce the topical TA as an effective and safe medication for the treatment of melasma.

Topical Tranexamic Acid is increasingly used for epistaxis, but previous evidence syntheses have reported low certainty due to small sample sizes and high heterogeneity. We aimed to evaluate the efficacy of topical tranexamic acid in adult anterior epistaxis and identify clinical factors, specifically the method of administration, that influence treatment success. We systematically searched PubMed, Embase, SCOPUS, and Web of Science for studies comparing topical tranexamic acid to standard care (nasal packing, vasoconstrictors, or placebo) for spontaneous anterior epistaxis. The primary outcome was bleeding cessation within 10 min. Secondary outcomes included emergency department length of stay and rebleeding rates (early and late). A subgroup analysis was conducted to compare the effects of different delivery methods on the success rate. Eighteen studies (16 RCTs, 2 prospective cohorts) involving 2760 patients were included. Topical tranexamic acid significantly reduced the mean time required to bleeding cessation, with a mean difference of -4.68 (95% CI -7.02; -2.34). Furthermore, it enhanced the probability of achieving bleeding cessation within 10 min (OR 2.54; 95% CI 1.22; 5.29) and reduced the risk of both early rebleeding (OR 0.42; 95% CI 0.29; 0.59) and late rebleeding (OR 0.45; 95% CI 0.24; 0.87). Patients treated with tranexamic acid were five times more likely to be discharged from the ED within two hours (OR 5.53). Subgroup analysis revealed that the method of administration was a critical moderator: tranexamic acid-saturated gauze provided a robust, consistent benefit (OR 2.98), whereas atomized delivery yielded inconsistent results (OR 0.29). Sensitivity analysis restricted to RCTs confirmed the stability of the primary effect (OR 2.50). Topical TXA could be superior to traditional management strategies for adult anterior epistaxis, offering faster hemostasis, reduced rebleeding, and shorter emergency department stays. However, efficacy is technique-dependent; saturated gauze/pledgets should be preferred over atomized delivery to ensure optimal and consistent treatment effect.

Introduction Posterior instrumented lumbar fusion (PLIF) is a commonly performed surgical procedure for degenerative lumbar spine disorders such as lumbar disc herniation, spinal stenosis, and spondylolisthesis. However, the procedure is frequently associated with significant intraoperative and postoperative blood loss due to extensive soft tissue dissection, exposure of cancellous bone, and injury to the epidural venous plexus. Excessive blood loss may result in postoperative anemia, increased transfusion requirements, delayed mobilization, prolonged hospital stay, and increased morbidity. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been widely used to reduce blood loss in orthopedic and spine surgeries. This study aimed to evaluate the effectiveness of preoperative local infiltration of TXA in reducing perioperative blood loss in posterior lumbar fusion surgery. Methodology This prospective controlled study was conducted in the Department of Orthopedics, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, from March 2023 to June 2024. A total of 40 patients with degenerative lumbar spine disorders planned for 2-3 level posterior lumbar fixation with or without interbody fusion were included and randomly allocated into two groups. Group 1 (n=20) received 1 g of TXA by preoperative local infiltration bilaterally into the paraspinal muscles before skin incision, while Group 2 (n=20) served as the control group without TXA infiltration. Demographic characteristics, preoperative hematological parameters, intraoperative blood loss, postoperative drain output on postoperative days (PODs) 1, 2, and 3, and postoperative hemoglobin and packed cell volume (PCV) were recorded. Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA), with p<0.05 considered statistically significant. Results Baseline demographic and preoperative hematological parameters were comparable between the groups. Although intraoperative blood loss was lower in the TXA group, the difference was not statistically significant. Postoperative drain output was significantly reduced in the TXA group on PODs 2 and 3 (p=0.006 and p<0.001, respectively). POD 3 hemoglobin and PCV were significantly higher in the TXA group (12.74±0.87 g/dL and 37.44±0.86%) compared to the control group (11.33±0.80 g/dL and 34.84±1.66%, respectively), with p<0.001 for both. The reduction in hemoglobin and PCV was significantly less in the TXA group. Conclusion Preoperative local infiltration of TXA is an effective and safe method for reducing postoperative blood loss and preserving postoperative hematological parameters in posterior instrumented lumbar fusion surgery. This technique may reduce transfusion requirements and improve postoperative recovery. Larger multicentric studies are recommended for further validation.

Tranexamic acid reduces perioperative bleeding in many surgical settings, but its safety in microvascular breast reconstruction remains incompletely defined given theoretical concerns for anastomotic thrombosis. We evaluated outcomes after routine perioperative tranexamic acid in abdominally based free-flap breast reconstruction and contextualized findings with the evolving microsurgical literature. A retrospective review was performed of consecutive patients undergoing abdominally based deep inferior epigastric perforator free-flap breast reconstruction by a single surgeon after adoption of routine tranexamic acid (February-December 2025). All included patients received 1 g intravenous tranexamic acid at anesthesia induction and an additional 1 g at closing. Primary outcomes included hematoma, flap thrombosis, venous thromboembolism, and transfusion. Secondary outcomes included wound complications, inpatient complications, and length of stay. Seventy-one reconstructions were performed in 46 patients (46 unilateral, 25 bilateral) with median follow-up of 6 months. Flap survival was 100% with no inpatient complications. No hematomas, flap thrombosis events, or transfusions occurred. Delayed complications occurred in 9 patients (19.6%), most commonly donor-site wound healing (8.7%) and skin-paddle healing (4.3%). Two patients (4.3%) required interventional radiology drainage for an abscess and seroma, and one patient experienced a segmental pulmonary embolism. In this single-surgeon series, perioperative tranexamic acid use during free flap breast reconstruction was safe and not associated with thrombotic or bleeding-related complications. Combined with the limited existing literature, these findings support tranexamic acid as a safe adjunct in microvascular breast reconstruction. Larger, multicenter prospective trials are needed to validate tranexamic acid's role in this population.