Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
01 11 2023
01 11 2023
Historique:
pubmed:
5
7
2023
medline:
5
7
2023
entrez:
5
7
2023
Statut:
ppublish
Résumé
Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery. A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output. Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003). This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.
Sections du résumé
BACKGROUND
Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery.
METHODS
A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output.
RESULTS
Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003).
CONCLUSIONS
This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.
Identifiants
pubmed: 37405863
doi: 10.1097/SAP.0000000000003635
pii: 00000637-202311000-00022
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
622-628Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Rohrich RJ, Cho MJ. The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg . 2018;141:507–515.
Lovely JK, Nehring SA, Boughey JC, et al. Balancing venous thromboembolism and hematoma after breast surgery. Ann Surg Oncol . 2012;19:3230–3235.
Daar DA, Bekisz JM, Chiodo MV, et al. Hematoma after non-oncologic breast procedures: a comprehensive review of the evidence. Aesthetic Plast Surg . 2021;45:2602–2617.
Allotey JK, King AH, Kumins NH, et al. Systematic review of hemostatic agents used in vascular surgery. J Vasc Surg . 2021;73:2189–2197.
Sundaram CP, Keenan AC. Evolution of hemostatic agents in surgical practice. Indian J Urol . 2010;26:374–378.
Schreiber MA, Neveleff DJ. Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings. AORN J . 2011;94:S1–S20.
Eustache G, Riffaud L. Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid. Neurochirurgie . 2019;65:302–309.
Eustache G, Nardi N, Rousseau C, et al. Importance of tranexamic acid in pediatric monosutural craniosynostosis surgery. J Neurosurg Pediatr . 2021;29:412–418.
Huerfano E, Huerfano M, Shanaghan K, et al. Use of topical tranexamic acid reduces direct and indirect blood loss and transfusion rates in revision total hip arthroplasty. HSS J . 2020;16(Suppl 2):285–292.
Kochuba AL, Coombs DM, Kwiecien GJ, et al. Prospective study assessing the effect of local infiltration of tranexamic acid on facelift bleeding. Aesthet Surg J . 2021;41:391–397.
Martin DT, Gries H, Esmonde N, et al. Implementation of a tranexamic acid protocol to reduce blood loss during cranial vault remodeling for craniosynostosis. J Craniofac Surg . 2016;27:1527–1531.
McGuire C, Nurmsoo S, Samargandi OA, et al. Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: a systematic review and meta-analysis. JAMA Facial Plast Surg . 2019;21:191–198.
Tzatzairis TK, Drosos GI, Kotsios SE, et al. Intravenous vs topical tranexamic acid in total knee arthroplasty without tourniquet application: a randomized controlled study. J Arthroplasty . 2016;31:2465–2470.
F.D.L.R.I. Cyklokapron (Tranexamic Acid Injection) . 2011. Reference ID 2896366. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/019281s030lbl.pdf . Accessed May 19, 2022.
Weissler JM, Banuelos J, Molinar VE, et al. Local infiltration of tranexamic acid (TXA) in liposuction: a single-surgeon outcomes analysis and considerations for minimizing postoperative donor site ecchymosis. Aesthet Surg J . 2021;41:NP820–NP828.
Cristel RT, Demesh D, Patel MJ, et al. Quantitative analysis of tranexamic acid effects on ecchymosis in rhinoplasty. Facial Plast Surg Aesthet Med . 2022;24:228–232.
Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee . 2006;13:106–110.
Ausen K, Hagen AI, Østbyhaug HS, et al. Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial. BJS Open . 2020;4:216–224.
Weissler JM, Banuelos J, Jacobson SR, et al. Intravenous tranexamic acid in implant-based breast reconstruction safely reduces hematoma without thromboembolic events. Plast Reconstr Surg . 2020;146:238–245.
Ausen K, Fossmark R, Spigset O, et al. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg . 2015;102:1348–1353.
Gogna S, Goyal P. Prospective randomized study on effect of tranexamic acid on wound drainage following modified radical mastectomy for cancer breast. Int J Curr Res . 2015;7:16192–16194.
Pathak S, Husain A, Sharma S, et al. Assessing the role of topical tranexamic acid application in post-reduction mammoplasty patients. Int J Contemp Med Res . 2016;3:1529–1531.
Wolter A, Scholz T, Pluto N, et al. Subcutaneous mastectomy in female-to-male transsexuals: optimizing perioperative and operative management in 8 years clinical experience. J Plast Reconstr Aesthet Surg . 2018;71:344–352.
Lardi AM, Dreier K, Junge K, et al. The use of tranexamic acid in microsurgery—is it safe? Gland Surg . 2018;7(Suppl 1):S59–S63.
Eldesouky MS, Abo Ashour HS, Shahin MA. Effect of topical application of tranexamic acid on reduction of wound drainage and seroma formation after mastectomy. Egypt J Surg . 2019;38:772–775.
Lohani KR, Kumar C, Kataria K, et al. Role of tranexamic acid in axillary lymph node dissection in breast cancer patients. Breast J . 2020;26:1316–1320.
Weissler JM, Kuruoglu D, Antezana L, et al. Efficacy of tranexamic acid in reducing seroma and hematoma formation following reduction mammaplasty. Aesthet Surg J . 2022;42:616–625.
Abboud NM, Kapila AK, Abboud S, et al. The combined effect of intravenous and topical tranexamic acid in liposuction: a randomized double-blinded controlled trial. Aesthet Surg J Open Forum . 2021;3:ojab002.
Mohan A, Rangwala M, Rajendran N. Use of tumescent anesthesia in surgical excision of gynecomastia. Surg Innov . 2022;29:22–26.
Nichols G, Andrade E, Gregoski M, et al. Local infiltration of tranexamic acid in breast reduction for symptomatic macromastia [published online February 20, 2023]. Ann Plast Surg . doi:10.1097/SAP.0000000000003456.
doi: 10.1097/SAP.0000000000003456
Brown S, Yao A, Taub PJ. Antifibrinolytic agents in plastic surgery: current practices and future directions. Plast Reconstr Surg . 2018;141:937e–949e.
Murphy GR, Glass GE, Jain A. The efficacy and safety of tranexamic acid in cranio-maxillofacial and plastic surgery. J Craniofac Surg . 2016;27:374–379.
Agrawal NA, Hillier K, Kumar R, et al. A review of venous thromboembolism risk assessment and prophylaxis in plastic surgery. Plast Reconstr Surg . 2022;149:121e–129e.
Calpin GG, McAnena PF, Davey MG, et al. The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: a meta-analysis. Surgeon . 2023;21:e183–e194.
Liechti R, van de Wall BJM, Hug U, et al. Tranexamic acid use in breast surgery: a systematic review and meta-analysis. Plast Reconstr Surg . 2023;151:949–957.
Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ . 2012;344:e3054.