# Topical tranexamic acid in mastectomies on haematoma formation: prospective cohort study

## TL;DR

Using topical tranexamic acid after mastectomy reduces the risk of postoperative hematoma and drain output within 24 hours.

## Contribution

This study demonstrates that retrograde instillation of topical tranexamic acid significantly reduces hematoma formation and drain output after mastectomy.

## Key findings

- TXA group had a 1.3% surgical revision rate for hematoma versus 6.8% in the control group (P = 0.005).
- Mean 24-hour drain output was 67.6 ml in the TXA group versus 103.9 ml in the control group (P = 0.001).
- No thromboembolic events were reported in either group.

## Abstract

Reports suggest tranexamic acid (TXA) reduces haematoma formation after breast surgery. This study investigated the effects of postoperative retrograde instillation of topical TXA through surgical drains on postoperative haematoma formation requiring surgical intervention and drain output 24 hours after mastectomy procedures.

A prospective cohort study was conducted from October 2020 until September 2023, comprising two consecutive periods. In the first period, women underwent mastectomy without receiving TXA (control); in the second, women received retrograde instillation of 20 ml of 50 mg/ml TXA into the drain immediately after cavity closure. This was performed as part of a change in routine practice in April 2023. Primary endpoints collected from patient medical records were haematoma formation requiring surgical intervention, mean drain output 24 hours after the procedure, and thromboembolic events. Type of surgery, age, body mass index, smoking status, the use of blood thinners, neoadjuvant therapy, and the indication for surgery were considered patient variables that could potentially affect primary endpoints. Regression analysis was used to analyse relationships between TXA administration and haematoma occurrence and drain output, adjusting for the specified patient variables. This study was designed in accordance with STROBE guidelines.

Among 297 breasts (271 women) receiving topical TXA and 278 breasts (264 women) in the control group, 4 (1%) and 19 (7%) breasts, respectively, had surgical revisions due to haematoma (P = 0.003). Drain output within the first 24 hours after the procedure was significantly lower in the TXA than control group (mean(standard deviation) 67.6(62.4) versus 103.9(106.6) ml, respectively; P < 0.001). No thromboembolic events were reported. Women in the control group had a higher body mass index and mean age, and a higher proportion underwent axillary clearance and received neoadjuvant therapy compared with the TXA group. A higher proportion of women in the TXA group underwent sentinel node biopsy. After adjusting for these variables, significant differences remained between the two groups in haematoma rate (P = 0.005) and drain output (P = 0.001).

Retrograde administration of 20 ml of 50 mg/ml topical TXA into the cavity after mastectomy significantly reduced the incidence of haematoma formation and drain output within the first 24 hours.

Topical administration of 20 ml of 50 mg/ml tranexamic acid (TXA) after mastectomy significantly reduces postoperative haematoma formation and drain output. In a study involving 297 breasts (271 women) treated with TXA and 278 breasts (264 women) that were not (control), the respective rates of surgical revision for haematoma were 1.3% and 6.8% (P = 0.005), and the mean drain output at 24 hours was 67.6 and 103.9 ml (P = 0.001). These findings highlight the effectiveness of TXA in reducing haematoma incidence and drain output during the first 24 hours after surgery.