Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a systematic review and meta-analysis on the results reported in the literature regarding the effect of perioperative systemic TXA administration in breast surgery. Methods: The PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases were searched for both randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio with corresponding 95% confidence interval. Results: A total of five studies encompassing 1139 patients undergoing mastectomy with or without immediate implant or free flap–based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%; OR, 0.43; 95% CI, 0.23 to 0.81) and seroma formation (11.5% versus 19.9%; OR, 0.57; 95% CI, 0.35 to 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132 mL (95% CI, 220 to 44 mL). No thromboembolic event occurred in either group. The weighted surgical-site infection rate was higher in the control group (3.1% versus 1.5%). However, these data were too sparse to perform comparative meta-analysis. Conclusion: Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery, whereas the risk for thromboembolic events and postoperative infection is not increased.

Tranexamic Acid in Tumescence for Cervicofacial Rhytidectomies

“…14 Further, intravenous administration of TXA periopeatively has even been found to significantly reduce hematoma risk in some procedures. 15 The most effective dosage of TXA in tumescence differs across literature, but in our study, most patients received a dosage of 1 mg of TXA per 1 mL of tumescent solution. Two hundred fifty milligrams of TXA is similar to doses of 1 mg per cc of tumescent solution recommended in the literature.…”

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

“…By including studies with any use of either IV or topical TXA, we have the largest sample size to date compared with previous reviews and add to the growing body of evidence that TXA, both IV and topical, may significantly affect breast surgery outcomes. With additional stratified analysis, we could further elucidate benefits of each specific administration modality and in various surgical cohorts compared with past reviews 34,35 . With the relatively small number of studies in the literature looking at TXA use in breast surgery, we feel that including all relevant studies with any use of TXA and of varying study design was important to obtain a larger sample.…”

“…With additional stratified analysis, we could further elucidate benefits of each specific administration modality and in various surgical cohorts compared with past reviews. 34,35 With the relatively small number of studies in the literature looking at TXA use in breast surgery, we feel that including all relevant studies with any use of TXA and of varying study design was important to obtain a larger sample. To address the variability, we performed subgroup analyses evaluating only topical TXA administration, IV TXA administration, and oncologic or nononcologic breast surgery.…”