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

BACKGROUND: Hematoma formation is a possible postoperative occurrence following breast surgery. It might increase the risk of long-term complications and thereby delay start of adjuvant therapy. Tranexamic acid (TXA) is suggested to decrease the risk of postoperative hematoma, but the evidence is based on small and heterogeneous studies. The primary objective of this systematic review and meta-analysis is to assess the impact of TXA on hematoma formation and secondarily on drain output, time upon drain removal, seroma formation, infection incidents, and thromboembolic events.

METHODS: A literature search was conducted in PubMed, Embase, Medline, Cochrane Library, and Google Scholar. Studies examining either intravenous or topically administered TXA were included and underwent risk of bias assessment.

RESULTS: A total of 989 studies were screened and 19 studies fulfilled the inclusion criteria. Of the 7673 breasts in total, topical TXA was given to 2106 breasts, intravenous to 1722 and the remaining 4347 breasts were controls having no TXA. Hematoma formation was significantly reduced by both topical administered TXA (RR, 0.33; 95% CI, 0.15-0.75) and intravenous TXA (RR, 0.45; 95% CI, 0.29-0.68) across all breast procedures. The same result was found when only including oncological breast procedures; topical TXA (RR, 0.16; 95% CI, 0.05-0.56) and intravenous TXA (RR, 0.50; 95% CI, 0.31-0.81). A reduction in drain output and time until drain removal was noted. No significant reduction in seroma formation was observed.

CONCLUSION: Both topical and intravenous TXA in breast surgery significantly reduce hematoma and reduce drain output and time upon drain removal. Studies show no effect on seroma formation, infection rates, or thromboembolic events.