“The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis”

Background: Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study is to determine the effect of TXA on post-operative blood loss in breast surgery. Methods: Searches of PubMed, Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized control trials that administered TXA (topical or IV) in the context of breast surgery. Quality of studies were evaluated using the RoB 2.0 and ROBINS-I tools, respectively. Data was pooled and a meta-analysis was performed. Results: In total, seven studies were included, representing 1226 patients (TXA = 632, control = 622 patients). TXA was administered: topically (20 mL of 25 mg/mL TXA intraoperatively; n=258 patients), intravenously (1-3 g perioperatively; n=743 patients), or both (1-3 g daily up to 5 days post-operatively; n=253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI 0.32 to 0.73), with no effect on drain output (mean difference, -84.12 mL; 95% CI -206.53 to 38.29), seroma formation (risk ratio, 0.92; 95% CI 0.60 to 1.40) or infection rates (risk ratio, 1.01; 95% CI 0.46 to 2.21). No adverse effects were reported. Conclusions: The use of TXA in breast surgery is a safe and effective modality with low level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.