The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: A meta-analysis.

Abstract

INTRODUCTION:

Tranexamic acid (TXA) reduces blood loss and blood transfusion requirements in surgery. Seroma and haematoma formation occur as complications of breast surgery. We aimed to perform a meta-analysis evaluating TXA in reducing post-operative haematoma and seroma formation for breast surgery.

METHODS:

A systematic review was performed in accordance with PRISMA guidelines. Results were expressed as dichotomous variables pooled as odds ratios (OR) with corresponding 95% confidence intervals (CIs) using the Mantel-Haenszel method.

RESULTS:

Seven studies including 1446 patients were included. There were 1830 breast surgery procedures performed with TXA administered in 797 cases (43.6%). There was a significant reduction in haematoma rates in the TXA group (TXA: 3.184% (22/691) vs Control: 6.787% (64/943), OR: 0.41, 95% CI: 0.20-0.86, P = 0.020). Based on surgical procedure, haematoma rates were similar for TXA and control groups in cancer surgery (P = 0.230). Haematoma rates reduced following TXA use in cosmetic procedures (TXA: 3.807% (15/394) vs. Control: 9.091% (34/374), OR: 0.41, 95% CI: 0.22-0.75, P = 0.004). Haematoma rates were also reduced in procedures where axillary lymph node dissection (ALND) was not performed; in the TXA group, 3.379% (22/651) developed a haematoma versus 6.623% (60/906) in the control group (OR: 0.45, 95% CI 0.27-0.77, P = 0.003). TXA administration did not impact seroma formation or infection rates.

CONCLUSION:

Perioperative administration of TXA may impact the incidence of haematoma in breast surgery, particularly in cosmetic procedures and procedures without ALND. Well-designed randomised studies are required to determine its true efficacy. TXA has no effect on seroma formation or infection in breast surgery.

• Authors: Gavin G Calpin, Peter F McAnena, Matthew G Davey, Pádraig Calpin, Michael J Kerin, Niall McInerney, Stewart R Walsh, Aoife J Lowery
• Journal: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland (Surgeon) Vol. 21 Issue 4 Pg. e183-e194 (Aug 2023) ISSN: 1479-666X [Print] Scotland
• PMID: 36572609 (Publication Type: Systematic Review, Meta-Analysis, Journal Article, Review)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Tranexamic Acid
• Antifibrinolytic Agents

Topics

• Humans
• Female
• Tranexamic Acid (therapeutic use)
• Antifibrinolytic Agents (therapeutic use)
• Seroma (etiology, prevention & control)
• Blood Loss, Surgical (prevention & control)
• Hematoma (prevention & control)
• Breast Neoplasms (surgery)