Tranexamic acid use in breast surgery: a systematic review and meta-analysis

Abstract

Background: We aimed to determine if tranexamic acid (TXA) is safe to use in breast surgery and does it reduce haematoma and seroma formation. Methods: Only high-quality randomized control trials (RCT’s) were included for the meta-analysis. Databases searched included Embase, Medline, the Cochrane Central Register of Controlled Trials, Mednar and google scholar. RCT’s study quality was assessed using the Cochrane risk of bias tool. Results: Ten studies were identified, 5 RCT’s and 5 non-RCT’s. Overall the risk of thromboembolic events was not significantly greater after TXA administration (P=0.35) in 2,283 patients from 8 studies. 4 RCT’s were included in the meta-analysis. For mastectomy patients with or without axillary surgery combined with mammoplasty procedures the rate of haematoma was unaffected [odds ratio (OR) =0.42, 95% confidence interval (CI): 0.19 to 0.76, P=0.30]. A small reduction in drainage volumes first 24 hours was observed [mean difference (MD) =−12 mL, 95% CI: −20.7 to −3.7, P=0.005], but no effect on late seroma formation (OR =1.04, 95% CI: 0.37 to 2.91, P=0.94). Conclusions: The overall quantity and quality of evidence for TXA use in breast surgery is extremely limited. The current study suggests there is likely to be minimal benefit, at least for mastectomy and mammoplasty patients, with a still undefined risk of thromboembolic events. No RCT’s were identified examining TXA use in breast reconstruction. then compared to