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      Versatilidad terapéutica del ácido tranexámico aplicado a la Cirugía Plástica. Revisión bibliográfica Translated title: Therapeutic versatility of tranexamic acid applied to Plastic Surgery. Bibliographic review

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          Abstract

          Resumen Introducción y objetivo. Son múltiples los cuidados perioperatorios para prevenir complicaciones, desde la adecuada selección del paciente hasta el uso de medicamentos para disminuir las pérdidas sanguíneas en el transoperatorio. La tendencia actual es prevenir antes que tratar y en múltiples cirugías se ha ensayado el ácido tranexámico con fines de ahorro de sangre, reducción de la equimosis e inflamación, y como despigmentante. Realizamos la presente investigación con el objetivo de mostrar la utilidad del ácido tranexámico e incrementar su uso en Cirugía Plástica para disminuir la pérdida sanguínea transoperatoria y como tratamiento de la hiperpigmentación, en pro de garantizar una mayor seguridad al paciente. Material y método. Revisión bibliográfica en Pubmed, Elsevier, Google Académico, Research y Scielo; artículos en inglés y español utilizando tres estrategias de búsqueda mediante combinación de descriptores con operadores booleanos, limitando el “AND” para términos diferentes y el “OR” para homólogos, entre 1968 y 2022. Resultados. A través del conocimiento de la farmacocinética del ácido tranexámico comprobamos que, además de su utilidad en la prevención del sangrado, a partir de la inhibición del complemento y de la síntesis de melanina tiene también utilidad demostrada como despigmentante en la hipercromía. Conclusiones. Este estudio contribuye a conocer mejor las utilidades del ácido tranexámico para prevenir el sangrado en la cirugía y como despigmentante cutáneo. Consideramos que este último aspecto abre una puerta de estudio de su aplicación en el tratamiento de la hiperpigmentación producida en la alogenosis iatrogénica, utilidad que se sumaría a las ya conocidas.

          Translated abstract

          Abstract Background and objective. There are multiple perioperative cares to prevent complications, from the proper selection of the patient to the use of medications to reduce blood loss during the transoperative period. The current trend is to prevent rather than treat, and tranexamic acid has been tested in multiple surgeries for purposes of saving blood, reducing ecchymosis and inflammation, and as a depigmentation agent. We carried out this research with the objective of showing the usefulness of tranexamic acid and increasing its use in Plastic Surgery to reduce intraoperative blood loss and as a treatment for hyperpigmentation, in order to guarantee greater patient safety. Methods. Literature review in Pubmed, Elsevier, Google Scholar, Research and Scielo; articles in English and Spanish using three search strategies by combining descriptors with boolean operators, limiting the "AND" for different terms and the "OR" for homologues, between 1968 and 2022. Results. Through the knowledge of the pharmacokinetics of tranexamic acid, we verified that, in addition to its usefulness in the prevention of bleeding, through the inhibition of complement and melanin synthesis it has also been shown to be useful as a depigmenting agent in hyperchromia. Conclusions. This study contributes to better understand the benefits of tranexamic acid to prevent bleeding in surgery and as a skin depigmentation agent. We believe that this last aspect opens a door for the study of its application in the treatment of hyperpigmentation produced in iatrogenic allogeneic disease, a utility that would be added to those already known.

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          Most cited references29

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          The dose-response relationship of tranexamic acid.

          Prophylactic administration of the antifibrinolytic drug tranexamic acid decreases bleeding and transfusions after cardiac operations. However, the best dose of tranexamic acid for this purpose remains unknown. This study explored the dose-response relationship of tranexamic acid for hemostatic efficacy after cardiac operation. In prospective, randomized, double-blinded fashion, 148 patients undergoing cardiac operation with extracorporeal circulation were divided into six groups: a placebo group and five groups receiving tranexamic acid in loading doses before incision (range 2.5 to 40 mg.kg-1) and one-tenth the loading dose hourly for 12 h. The mass of blood collected by chest tubes over 12 h represented blood loss. Allogeneic transfusions within 12 h and within 5 d of surgery were tallied. The six groups presented similar demographics. Patients receiving placebo had increased postoperative D-dimer concentration compared to groups receiving tranexamic acid. Patients receiving at least 10 mg.kg-1 tranexamic acid followed by 1 mg.kg-1.h-1 bled significantly less (365, 344, and 369 g.12 h-1, respectively, for those three groups) compared with patients who received placebo (552 g, P < 0.05). Tranexamic dose did not affect transfusions. Only initial hematocrit affected whether a patient received an allogeneic transfusion within 5 days of operation (odds ratio 2.08 for each 3% absolute decrease in hematocrit). Prophylactic tranexamic acid, 10 mg.kg-1 followed by 1 mg.kg-1.h-1, decreases bleeding after extracorporeal circulation. Larger doses do not provide additional hemostatic benefit.
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            The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis

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              Mortality in outpatient surgery.

              The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has reported statistics on morbidity and mortality for facilities that it accredits based on an analysis of unanticipated sequelae and surgical mortality. Data acquired through the first Internet-Based Quality Assurance and Peer Review reporting system (IBQAP) were reviewed and published in 2004. This article reports the accumulated data in the IBQAP through June of 2006, analyzing death associated with procedures performed in facilities approved by the AAAASF. With the exception of some statistics on the Medicare-aged population, there are few data reported in the literature related to deaths in outpatient surgery. The IBQAP, designed in 1999 by the AAAASF, mandates biannual reporting of all unanticipated sequelae and random case reviews by all surgeons operating in AAAASF-accredited facilities. Surgical log numbers, whose entry is required, allow for tabulation of the number of cases and procedures performed by individual reporting surgeons. In this review of data collected using the IBQAP from January of 2001 through June of 2006, there were 23 deaths in 1,141,418 outpatient procedures performed. Pulmonary embolism caused 13 of the 23 deaths. Only one death occurred as the result of an intraoperative adverse event. A pulmonary embolism may occur after any operative procedure, whether it is performed in a hospital, an ambulatory surgery center, or a physician's office-based surgery facility. The procedure most commonly associated with death from pulmonary embolism in an office-based surgery facility is abdominoplasty. The frequency of pulmonary embolism associated with abdominoplasty warrants further study to determine predisposing factors, understand its cause, and introduce guidelines to prevent its occurrence.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                December 2022
                : 48
                : 4
                : 383-394
                Affiliations
                [3] Saltillo Coahuila orgnameAsociación Mexicana de Cirugía Plástica, Estética y Reconstructiva orgdiv1Comité de Seguridad México
                [2] La Habana orgnameHospital Clínico Quirúrgico “Hermanos Ameijeiras” orgdiv1Servicio de Cirugía Plástica y Caumatología Cuba
                [1] La Habana orgnameHospital Clínico Quirúrgico “Hermanos Ameijeiras” orgdiv1Servicio de Cirugía Plástica y Caumatología Cuba
                Article
                S0376-78922022000400005 S0376-7892(22)04800400005
                10.4321/s0376-78922022000400005
                cb1ec45a-c080-4fde-bd46-07d161fbed83

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 21 September 2022
                : 25 November 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 12
                Product

                SciELO Spain

                Categories
                Tema Especial

                Tranexamic acid,Plastic Surgery,Hyperpigmentation,Hemorrhage,Bleeding,Ácido tranexámico,Cirugía Plástica,Hiperpigmentación,Hemorragia,Sangrado

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