Videos of Surgical Procedures in Dermatology
Tranexamic Acid for Bleeding Control During a Hair Transplant Procedure
Hemostasia con ácido tranexámico durante trasplante capilar
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Mendieta-Eckert, R. Rodero Ortiz, R. Rincón Piñeiro, N. Landa Gundin" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Mendieta-Eckert" "email" => array:1 [ 0 => "mmendieta@dermitek.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Rodero Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Rincón Piñeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Landa Gundin" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Clínica Dermitek, Bilbao, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Equipo de Trasplante Capilar, Clínica Dermitek, Bilbao, Vizcaya, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemostasia con ácido tranexámico durante trasplante capilar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hair transplant surgery is a growing trend. Although it produces good results, it is a laborious procedure and intraoperative complications may occur. One noteworthy complication is local bleeding, which can increase the difficulty of the procedure. We present the case of a patient with hemophilia A and describe how we managed intraoperative bleeding during follicular unit extraction (FUE).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 35-year-old man who had been diagnosed with mild hemophilia A (factor VII, 27%) after a bleeding episode during dental extraction. Desmopressin was necessary to control the bleeding. The patient came to our clinic for a hair transplant. Given his history of hemophilia, we consulted the hematology department, who recommended prior administration of desmopressin. This option, however, was ruled out as the scheduling of the procedure was incompatible with the hours of the day hospital. We therefore decided to administer oral tranexamic acid (TXA) 500<span class="elsevierStyleHsp" style=""></span>mg on the day of the procedure and every 6 to 8 hours for the following 48<span class="elsevierStyleHsp" style=""></span>hours. The patient underwent hair transplant with the FUE technique, which required the extraction of 1535 follicular units. Topical TXA was applied throughout to control bleeding by gentle compression with a gauze soaked in injectable TXA solution (Amchafibrin 500<span class="elsevierStyleHsp" style=""></span>mg) (<a class="elsevierStyleCrossRef" href="#sec0035">Supplementary Material</a>). Topical use of TXA reduced the bleeding after just a few minutes, allowing better visualization of incisions and facilitating the implantation of the harvested hair.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications and Contraindications of the Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">TXA is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin. It is indicated for the treatment and prevention of bleeding in hemophiliac patients, women with heavy menstruation, and in prostate and bladder surgery. Topical TXA was also recently described as a useful option for arthroplasty<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and for epistaxis and oral or rectal bleeding in emergency departments.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> It also appears to have an anti-inflammatory effect.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Namazi<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> proposed adding an ampoule of TXA (5<span class="elsevierStyleHsp" style=""></span>mL, 500<span class="elsevierStyleHsp" style=""></span>mg) to the tumescent anesthetic solution during hair transplantation to ease and shorten the procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Topical TXA appears to be an interesting option for both donor and recipient sites. We, however, consider that it is more useful for recipient sites, as this is where most manipulation is needed and where bleeding can complicate the implantation of the extracted follicular units. In addition, compression at donor sites during FUE may be sufficient in patients without disease or not on anticoagulation therapy.</p><p id="par0035" class="elsevierStylePara elsevierViewall">No studies have analyzed the potential effects of TXA on graft survival. However, one would expect this not to be affected, as TXA facilitates the procedure by shortening surgery time, inhibits fibrinolysis without causing vasoconstriction, is associated with few adverse effects (essentially allergic reactions), and has a half-life of just 3 hours when the oral formulation is used (and probably less when the topical formulation is used). The clinical outcome in the case presented is as expected after a follow-up period of 4 months.</p><p id="par0040" class="elsevierStylePara elsevierViewall">TXA is mainly contraindicated in severe kidney failure and should be avoided in patients on hormonal contraceptives as it carries an increased risk of thrombosis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Our patient did not develop any complications or adverse effects. The risk of adverse effects with topical TXA is low.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Intravenous TXA, however, appears to increase the risk of ischemic events, although nausea and diarrhea are more common.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Topical TXA appears to be an effective means of controlling mild to moderate bleeding. In addition, it is noninvasive, safe, and inexpensive. Its use in hair transplantation procedures could be extended to patients without medical conditions or under treatment with antiplatelets or anticoagulants.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications and Contraindications of the Technique" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Complications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mendieta-Eckert M, Rodero Ortiz R, Rincón Piñeiro R, Landa Gundin N. Hemostasia con ácido tranexámico durante trasplante capilar. Actas Dermosifiliogr. 2020;111:421–422.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0065" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 6058574 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tranexamic acid plus low-dose epinephrine reduces blood loss in total knee arthroplasty: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.G. Wu" 1 => "Y. Zeng" 2 => "Q.S. Hu" 3 => "X.C. Bao" 4 => "H.Z. Xiong" 5 => "B. Shen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Orthop Surg" "fecha" => "2018" "volumen" => "10" "paginaInicial" => "287" "paginaFinal" => "295" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supportive topical tranexamic acid application for hemostasis in oral bleeding events-retrospective cohort study of 542 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Zirk" 1 => "M. Zinser" 2 => "J. Buller" 3 => "V. 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| 2021 July | 63 | 27 | 90 |
| 2021 June | 89 | 32 | 121 |
| 2021 May | 76 | 53 | 129 |
| 2021 April | 137 | 53 | 190 |
| 2021 March | 193 | 30 | 223 |
| 2021 February | 87 | 29 | 116 |
| 2021 January | 60 | 25 | 85 |
| 2020 December | 66 | 17 | 83 |
| 2020 November | 41 | 15 | 56 |
| 2020 October | 79 | 34 | 113 |
| 2020 September | 176 | 27 | 203 |
| 2020 August | 91 | 22 | 113 |
| 2020 July | 77 | 34 | 111 |
| 2020 June | 8 | 17 | 25 |
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