Serum Concentrations and Pharmacokinetics of Tranexamic Acid after Two Means of Topical Administration in Massive Weight Loss Skin-Reducing Surgery

Kjersti Ausen, Hilde Pleym, Jiayin Liu, Solfrid Hegstad, Håvard Bersås Nordgård, Ivan Pavlovic, Olav Spigset, Kjersti Ausen, Hilde Pleym, Jiayin Liu, Solfrid Hegstad, Håvard Bersås Nordgård, Ivan Pavlovic, Olav Spigset

Abstract

Background: Topical administration of tranexamic acid to reduce bleeding is receiving increasing attention, as it is inexpensive, simple, and possibly beneficial in most surgery. Concerns regarding potential systemic adverse effects such as thromboembolic events and seizures may prevent general use of tranexamic acid. Although serum concentrations after topical application are assumed to be low, proper pharmacokinetic studies of tranexamic acid after topical application are lacking.

Methods: The authors have investigated systemic absorption of tranexamic acid after two means of topical administration in patients undergoing abdominoplasty after massive weight loss: a bolus of 200 ml of 5 mg/ml into the wound cavity versus moistening the wound surface with 20 ml of 25 mg/ml. Twelve patients were recruited in each group. Serum concentrations achieved were compared with those after administration of 1 g as an intravenous bolus to arthroplasty patients. Serial blood samples for tranexamic acid analysis were obtained for up to 24 hours.

Results: After intravenous administration, the peak serum concentration was 66.1 ± 13.0 µg/ml after 6 ± 2 minutes. Peak serum concentration after topical moistening was 5.2 ± 2.6 µg/ml after 80 ± 33 minutes, and in the topical bolus group, it was 4.9 ± 1.8 µg/ml after 359 ± 70 minutes. Topical moistening resulted in homogenous and predictable absorption across the individuals included, whereas topical bolus administration caused variable and unpredictable serum concentrations.

Conclusion: Topical administration of tranexamic acid in patients undergoing abdominoplasty results in low serum concentrations, which are highly unlikely to cause systemic effects.

Figures

Fig. 1.
Fig. 1.
Mean serum concentration versus time (minutes) after (above) intravenous bolus administration of 1 g of tranexamic acid (TXA); (center) topical bolus administration of 1 g of tranexamic acid; or (below) topical moistening with 500 mg of tranexamic acid. Error bars = 1 SD. The dotted line represents a concentration of 10 µg/ml, which is considered a threshold value for inhibition of fibrinolysis in adults. Individual patient curves are presented in Supplemental Digital Content 3 through 5.

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