“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

Abstract

Background: Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study was to determine the effect of TXA on postoperative blood loss in breast surgery. Methods: Searches of the PubMed, Ovid MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized controlled trials that administered TXA (topical or intravenously) in the context of breast surgery. Quality of studies were evaluated using the risk of bias in randomized trials tool and the risk of bias in nonrandomized studies of interventions tool. Data were pooled, and a meta-analysis was performed. Results: In total, seven studies were included, representing 1226 patients (TXA, 632 patients; control, 622 patients). TXA was administered as follows: topically (20 mL of 25 mg/mL TXA intraoperatively; n =258 patients), intravenously (1 to 3 g perioperatively; n = 743 patients), or both (1 to 3 g daily up to 5 days postoperatively; n = 253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI, 0.32 to 0.73), with no effect on drain output (mean difference, −84.12 mL; 95% CI, −206.53 to 38.29 mL), seroma formation (risk ratio, 0.92; 95% CI, 0.60 to 1.40), or infection rates (risk ratio, 1.01; 95% CI, 0.46 to 2.21). No adverse effects were reported. Conclusion:The use of TXA in breast surgery is a safe and effective modality with low-level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.

A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery

“…All studies included in our review showed decreased rates of drainage output. Our findings are similar to Calpin et al (Calpin et al 2023 ) and opposite to Huynh et al (Huynh et al 2023 ) previous meta-analyses regarding breast surgeries.…”

Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2024

“…New recommendations on two frequently used adjuncts have been included this year. Tranexamic acid, applied either systemically or topically, has been shown to prevent hematoma and seroma in some studies, but the evidence is not conclusive (LoE 2b/B/AGO +/−) [70,71]. Topical application of nitroglycerin ointment in the setting of mastectomy with or without reconstruction significantly reduced skin and nipple necrosis rates in meta-analyses [72][73][74].…”

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

“…While extant research underscores the potential benefits of TXA, discrepancies exist, with some studies presenting conflicting findings regarding its efficacy in specific subsets of trauma patients, one study conducted a systematic review and bias-adjusted meta-analysis of RCTs, highlighting the significant reduction in the risk of death due to bleeding with TXA, without an increased risk of vascular occlusive events [ 7 ]. Conversely, another study emphasized the ongoing investigation into the optimal dosing and timing of TXA administration in non-trauma surgical populations, indicating the lack of conclusive evidence in this patient group [ 8 ]. These findings echo those of other reports in the literature, suggesting that the debate on TXA’s benefits in trauma injury surgeries remains unresolved [ 9 , 10 ].…”