Published : 6 March 2024

The Efficacy of Topical Tranexamic Acid in Breast Surgery Evaluating The Drain Output and Complications Reduction: A Systematic Review and Meta-Analysis

  • Jesica Putri Sudarman
  • Iqbal F. Sayudo
  • Marcelvina Mutiara Putri
  • Gary Ali
  • Nurliati Sari Handini

Volume 11, Issue 1, (2024) Jurnal Plastik Rekonstruksi | Pages : 1-13

DOI: 10.14228/jprjournal.v11i1.370   Reader : 31 times PDF Download : 7 times

Abstract

Introduction : The topical administration of Tranexamic Acid (TXA) has gained significant attention for its potential advantages in various plastic surgery procedures. This study aims to conduct a systematic review and meta-analysis focusing on the use of topical TXA in breast surgery, analysing its impact on postoperative drain output and complications.
Method : PubMed, Embase and the Cochrane Library databases were systematically searched to identify relevant studies. The data synthesis utilized random-effects models and the findings were presented as a mean difference and weighted odds ratio along with the corresponding 95% confidence interval.
Results : Seven studies including four RCTs and three observational studies, comprising 1,553 breasts undergoing surgery were included. The average age of participants was 46 years; mean body mass index (BMI) was 26.1 kg/mm2. Of the breasts studied, 764 (49%) received topical TXA and 789 (51%) received normal saline as placebo. Overall, topical TXA was associated with a lower drain output in the first 24 hours postoperative (MD -25.87; p=0.00001) and a lower cumulative drain output (MD -59.72; p<0.00001). The rate of hematoma is significantly lower in the topical TXA group compared to the control group (OR 0.19; p=0.0009). There were no significant differences in rates of seroma, infection, thromboembolic events and time to drain removal between groups.  
Conclusion: Evidence of this study suggests that administration of topical TXA significantly reduces the drain output production and hematoma in breast surgery. The use of topical TXA not significantly affecting rates of seroma, infection and postoperative duration with drain.

Data Availability

All data generated during this study are included in this published article [and its supplementary information files].

References

  1. Seth AK, Hirsch EM, Kim JY, Dumanian GA, Mustoe TA, Galiano RD, Fine NA. Hematoma after mastectomy with immediate reconstruction an analysis of risk factors in 883 patients. Annals of plastic surgery. 2013 Jul 1;71(1):20-3.
  2. Manrique OJ, Banuelos J, Abu-Ghname A, Nguyen MD, Tran NV, Martinez-Jorge J, Harless C, Sharaf B, Jakub JW, Degnim AC, Boughey JC. Surgical outcomes of prepectoral versus subpectoral implant-based breast reconstruction in young women. Plastic and Reconstructive Surgery–Global Open. 2019 Mar 1;7(3):e2119.
  3. Ausen K, Hagen AI, Østbyhaug HS, Olafsson S, Kvalsund BJ, Spigset O, Pleym H. Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial. BJS open. 2020 Apr;4(2):216-24.
  4. Huynh MN, Wong CR, McRae MC, Voineskos S, McRae MH. The effects of tranexamic acid in breast surgery: a systematic review and meta-analysis. Plastic and Reconstructive Surgery. 2023 Dec 1;152(6):993e-1004e.
  5. Chauncey JM, Wieters JS. Tranexamic acid. InStatPearls [Internet] 2023 Jul 24. StatPearls Publishing.
  6. Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, Lavallée LT, Fergusson DA, Breau RH. The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfusion Medicine Reviews. 2018 Jul 1;32(3):165-78.
  7. Scomacao I, Cummins A, Roan E, Duraes EF, Djohan R. The use of surgical site drains in breast reconstruction: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020 Apr 1;73(4):651-62.
  8. Chua C, Bascone CM, Pereira C, Hai J, Park J, Hideshima K, Bhatti S, Nemanpour S, Leon B, Han G. Final 24-hour drain output and postoperative day are poor indicators for appropriate drain removal. Plastic and Reconstructive Surgery–Global Open. 2022 Apr 1;10(4):e4160.
  9. Liechti R, Fourie L, Fischli S, Metzger J. Symptomatic lymphangioma of the adrenal gland: a case report. Journal of Surgical Case Reports. 2018 May;2018(5):rjy106.
  10. Jpt H. Cochrane handbook for systematic reviews of interventions. http://www. cochrane-handbook. org. 2008.
  11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021 Mar 29;372.
  12. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR. RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj. 2019 Aug 28;366.
  13. Higgins J, Morgan R, Rooney A, Taylor K, Thayer K, Silva R, Lemeris C, Akl A, Arroyave W, Bateson T, Berkman N. Risk Of Bias In Non‑randomized Studies‑of Exposure (ROBINS‑E): Launch version. Risk Of Bias. 2022.
  14. Review Manager 5 (RevMan 5) [Computer program]. Version 5.4. Copenhagen: The Cochrane Collaboration, 2020.
  15. Bae J, Lee DD, Lee KT, Pyon JK, Jeon BJ, Mun GH. The early postoperative effects of rinsing the breast pocket with tranexamic acid in prepectoral prosthetic breast reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2024 Feb 1;89:125-33.
  16. Safran T, Vorstenbosch J, Viezel-Mathieu A, Davison P, Dionisopoulos T. Topical tranexamic acid in breast reconstruction: A double-blind randomized controlled trial. Plastic and Reconstructive Surgery. 2023 Oct 1;152(4):699-706.
  17. Eldesouky MS, Ashour HS, Shahin MA. Effect of topical application of tranexamic acid on reduction of wound drainage and seroma formation after mastectomy. The Egyptian Journal of Surgery. 2019 Oct 1;38(4):772-5.
  18. Yao A, Wang F, Benacquista T, Draper LB, Garfein ES, Monaco C, Tepper OM, Weichman KE, Ricci JA. Topical tranexamic acid does not reduce the incidence of hematoma in reduction mammoplasty: a double-blinded, randomized placebo-controlled trial. Plastic and Reconstructive Surgery. 2023:10-97.
  19. Sipos K, Kämäräinen S, Kauhanen S. Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023 Aug 1;83:172-9.
  20. Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Journal of British Surgery. 2015 Oct;102(11):1348-53.
  21. Calpin GG, McAnena PF, Davey MG, Calpin P, Kerin MJ, McInerney N, Walsh SR, Lowery AJ. The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: a meta-analysis. The Surgeon. 2023 Aug 1;21(4):e183-94.
  22. Lyons N, Heron P, Bethune R. Improving the recording of surgical drain output. BMJ Open Quality. 2015 Jan 1;4(1):u209264-w3964.
  23. Ramesh BA, Evans JT, BK J. Suction Drains. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
  24. Chua C, Bascone CM, Pereira C, Hai J, Park J, Hideshima K, Bhatti S, Nemanpour S, Leon B, Han G. Final 24-hour drain output and postoperative day are poor indicators for appropriate drain removal. Plastic and Reconstructive Surgery–Global Open. 2022 Apr 1;10(4):e4160.
  25. Oertli D, Laffer U, Haberthuer F, Kreuter U, Harder F. Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer. Journal of British Surgery. 1994 Jun;81(6):856-9.
  26. Palubicka A, Jaworski R, Wekwejt M, Swieczko-Zurek B, Pikula M, Jaskiewicz J, Zielinski J. Surgical site infection after breast surgery: a retrospective analysis of 5-year postoperative data from a single center in Poland. Medicina. 2019 Aug 21;55(9):512.
  27. Lohani KR, Kumar C, Kataria K, Srivastava A, Ranjan P, Dhar A. Role of tranexamic acid in axillary lymph node dissection in breast cancer patients. The Breast Journal. 2020 Jul;26(7):1316-20.
  28. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. Bmj. 2012 May 20;344.
  29. Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, Ker K. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane database of systematic reviews. 2011(3).
PDF

Keywords

  • Tranexamic acid
  • Breast
  • Reduction mammaplasty
  • Mastectomy
  • Antifibrinolytic agents

Author Information

Jesica Putri Sudarman

Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.

Email: cikasudarman@gmail.com

Iqbal F. Sayudo

Universitas Syiah Kuala, Banda Aceh, Indonesia.

Email: iqbalfsay@gmail.com

Marcelvina Mutiara Putri

Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.

Email: marcelvinamp@gmail.com

Gary Ali

Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.

Email: garyalisuryanto@gmail.com

Nurliati Sari Handini

Rumah Sakit Atma Jaya, Jakarta, Indonesia.

Email: nshandini@gmail.com

Article History

Submitted : 3 January 2025
Revised : 3 January 2025
Published : 6 March 2024

How to Cite This

Sudarman, J. P., Sayudo, I. F., Putri, M. M., Ali, G., & Handini, N. S. (2024). The Efficacy of Topical Tranexamic Acid in Breast Surgery Evaluating The Drain Output and Complications Reduction: A Systematic Review and Meta-Analysis. Jurnal Plastik Rekonstruksi, 11(1), 1–13. https://doi.org/10.14228/jprjournal.v11i1.370

Crossmark and Dimension

Verify authenticity via CrossMark

Share This Article

Copyright & License

Authors retain the copyright of the article and grant Jurnal Plastik Rekonstruksi the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License. Articles opting for open access will be immediately available and permanently free for everyone to read, download and share from the time of publication.

This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Open Access Statement

Jurnal Plastik Rekonstruksi is an open access journal. This journal provides immediate open access to every article on the principle that making research freely accessible to the public; It supports a greater global exchange of knowledge; and an invaluable way to boost the visibility and impact of research.

This also means that Jurnal Plastik Rekonstruksi it's free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than that inseparable from gaining access to the Internet itself.

Journal Info

Profile Image
Editor-in-Chief: dr. Narottama Tunjung, Sp.B.P.R.E., F.L.
Frequency: 2 issues per year (March & September)
National Accreditation: Sinta 3
Email: info@jprjournal.com

Video Article

Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction

Atmodiwirjo P, Ramadan MR, Triatmoko SE, Arina MN. Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction. J Plast Rekons 2020;7(1):38-42. DOI: https://doi.org/10.14228/jpr.v7i1.298

How to Harvest The Radial Forearm Free Flap

Atmodiwirjo P, Ramadan MR, Triatmoko SE, Ralena NA. How to Harvest Radial Forearm Free Flap. J Plast Rekons 2020;7(1):7-9. DOI: https://doi.org/10.14228/jpr.v7i1.296  

ACCREDITATION

Since October 2020, Jurnal Plastik Rekonstruksi has received Accreditation from the Ministry of Technology Research / National Research and Innovation Agency (SINTA 3)

https://sinta.ristekbrin.go.id/journals/detail?id=2054

Indexed by:

   

.    

custom_header

ISSN : 2089-6492
Online ISSN : 2089-9734
Publisher: The Lingkar Studi Bedah Plastik Foundation and is the official journal of Plastic Reconstructive and Aesthetic Surgery Residency Program, Faculty of Medicine, Universitas Indonesia.

Current Issue