Intravenous Versus Subcutaneous Tranexamic Acid in Liposuction: A Comparative Analysis of Efficacy and Safety.

Background: Liposuction is among the most carried-out aesthetic procedures in the world and is usually associated with considerable intraoperative blood loss. Tranexamic acid is an antifibrinolytic agent commonly used to minimize blood loss during surgery. However, there is scant evidence regarding the comparative efficacy and safety of intravenous administration versus subcutaneous administration during liposuction.

Methods: PRISMA guidelines were followed for this systematic review and meta-analysis. A total of 10 studies that investigated TXA in liposuction published from 2000 to 2024 were identified from the overall search across PubMed, Google Scholar, and Ovid. Main outcomes evaluated the changes in hematologic parameters (hemoglobin and hematocrit), perioperative blood loss, and postoperative complications. Random-effects models and network meta-analyses comparing IV and SC routes of administration were conducted.

Results: TXA significantly reduced intraoperative blood loss and improved postoperative hematologic stability. IV TXA proved to be more effective with a decrease in hematocrit change than SC (MD - 2.43, 95% CI [- 3.84, - 1.03]) and placebo (MD - 3.06, 95% CI [- 4.36, - 1.76]), while SC TXA showed a significant improvement in postoperative hemoglobin levels (MD 0.54, 95% CI [0.07, 1.01]). Both routes were associated with low complication rates, and no thromboembolic event was noted in either group.

Conclusion: TXA is effective in reducing blood loss during liposuction, with IV administration showing greater hematologic stabilization. SC administration remains a safe and viable alternative. Further high-quality trials are needed to refine dosing strategies and explore long-term outcomes.

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