A Prospective Study of the Role of Tranexamic Acid in Postoperative Bleeding and Seroma in Modified Radical Mastectomy

TL;DR

This study investigates whether tranexamic acid reduces bleeding and seroma after mastectomy surgery.

Contribution

The study evaluates tranexamic acid's effectiveness in modified radical mastectomy for postoperative bleeding and seroma.

Findings

Tranexamic acid significantly reduced intraoperative blood loss and late postoperative drain output.

Hospital stay was shorter in the tranexamic acid group.

Seroma formation was not significantly reduced by tranexamic acid.

Abstract

Background: Modified radical mastectomy (MRM) is a common surgical procedure for breast cancer, but is frequently complicated by seroma formation and postoperative bleeding, leading to morbidity and delayed recovery. Tranexamic acid (TXA), an antifibrinolytic agent, has shown efficacy in reducing blood loss across surgical specialties. This study evaluates its role in minimizing postoperative bleeding and seroma formation following MRM.

Methods: A non-randomized interventional study was conducted at the Department of General Surgery, All India Institute of Medical Sciences (AIIMS), Bhopal, from April 2023 to August 2024. Fifty female breast cancer patients undergoing MRM were enrolled and allocated to two groups: TXA group (n=25) and non-TXA group (NTXA, n=25). The TXA group received 1 g IV TXA at anesthesia induction, followed by 500 mg orally every eight hours for five days. Demographic variables, comorbidities, intraoperative blood loss, and postoperative parameters (daily and total drain output, drain duration, seroma formation, wound healing, and hospital stay) were recorded. Data were analyzed using IBM SPSS Statistics, version 25 (IBM Corp., Armonk, USA), with p < 0.05 considered significant.

Results: Both groups were comparable with reference to age, BMI, and clinical stage. Mean intraoperative blood loss was significantly lower in the TXA group (84.8 ± 32.06 ml) compared to the NTXA group (106.4 ± 37.95 ml; p = 0.04). Although total drain output (p = 0.33) and drain duration (p = 0.36) were not significantly different, daily drain output was significantly lower in the TXA group from Day 4 onwards (Day 4, p = 0.03; Day 5, p = 0.04; Day 6, p = 0.02; Day 7, p = 0.02). Seroma formation after drain removal occurred in 3 (12%) of TXA patients versus 5 (20%) in the NTXA group, but this was not statistically significant (p = 0.70). The mean hospital stay was significantly shorter in the TXA group (6.13 ± 2.29 days) than in the NTXA group (7.40 ± 1.84 days; p < 0.01).

Conclusion: Tranexamic acid significantly reduces intraoperative blood loss and late postoperative drain output in MRM patients. However, it does not significantly decrease overall seroma incidence or drain duration. Importantly, TXA use was associated with a shorter hospital stay. Larger randomized controlled trials are warranted to validate its role in reducing postoperative complications following MRM.

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