DOI: 10.1093/bjs/znad258.475 ISSN:

544 Effect of Tranexamic Acid on Microvascular Thrombosis in Autologous Free Tissue Transfer

S H Leow, A Arnaout, H Ridha
  • Surgery



The use of Tranexamic Acid (TXA) has been shown to be effective in reducing haemorrhage and mortality in numerous surgical settings and has a wide range of proposed benefits linked to anti-inflammatory effects which promotes healing and reduces pain and discomfort. However, the surgical community has been reluctant to incorporate TXA use into mainstream practices in microvascular surgery due to possible risk of thromboembolic events. Hence, we aim to report our experience with the use of TXA in microsurgical reconstruction.


We performed a retrospective single-centre cohort study including any patients who underwent autologous free flap tissue transfer at a district general hospital, from 1 January 2016 to 20 April 2022. The Chi-squared test was used to determine if there were any significant differences between the proportion of patients who developed any evidence of microvascular thrombosis, flap failure, or return to theatre. Univariate logistic regression was used to calculate odds ratio.


The treatment group (N = 160) received TXA (1g intravenous) at the time of general anaesthetic induction as per the senior author’s routine practice, while the control group (N = 80) did not receive TXA at any point of the hospital admission, according to the normal practice of other surgeons. No differences were found between the proportion of patients who developed flap failure, venous congestion or were returned to theatre between the TXA and control group.


Our study shows that TXA administration did not increase microvascular thrombosis in free flap reconstructive surgery, contributing evidence that TXA is safe to use in microvascular surgery.

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