Impact of intraoperative intravenous tranexamic acid on hematomas and bleeding events in gender-affirming vaginoplasty patients

Abstract

One of the more common and disruptive complications of gender-affirming vaginoplasty is postoperative bleeding. The present study aimed to evaluate the impact of intraoperative intravenous tranexamic acid (IV TXA) administration on postoperative bleeding events in a large sample of gender-affirming vaginoplasty patients. Patients undergoing gender-affirming vaginoplasty between June 2019 and July 2023 were evaluated retrospectively. IV TXA use, estimated blood loss, and bleeding complications were evaluated. Postoperative complications included minor hematomas, defined as hematomas requiring conservative treatment; major hematomas, defined as hematomas requiring intervention such as return to the operating room and readmission; major bleeding, defined as continuous bleeding from the surgical site requiring intervention; and readmission and reoperation related to bleeding. Statistical significance was set at p < 0.05. In total, 628 patients were included in the study, 271 did not receive IV TXA and 357 received IV TXA. Surgeon preference dictated IV TXA use. Significantly fewer patients in the IV TXA group had hematoma (18% vs. 2%, p < 0.001), minor hematoma (16% vs. 3%, p < 0.001), postoperative major bleeding (4% vs. 2%, p = 0.008), and readmission for bleeding (6% vs. 1%, p = 0.018). Logistic regression analysis revealed that IV TXA use was associated with decreased odds of developing any type of hematoma (OR 0.140, 95% CI 0.071-0.277, p < 0.001), minor hematoma (OR 0.126, 95% CI 0.059-0.270, p < 0.001), and postoperative bleeding (OR 0.348, 0.153-0.794, p = 0.012). The use of IV TXA reduced certain bleeding events and complications that can cause distress in the postoperative period in gender-affirming vaginoplasty patients.

Keywords: Bleeding; Gender-affirming vaginoplasty; Hematoma; Hemostatic agent; Tranexamic acid.