Link to article: Intravenous Tranexamic Acid
in Implant-Based Breast Reconstruction Safely Reduces Hematoma without
Thromboembolic Events
by Weissler, Jason M.; Banuelos, Joseph; Jacobson, Steven
R.; Manrique, Oscar J.; Nguyen, Minh-Doan T.; Harless, Christin A.; Tran, Nho
V.; Martinez-Jorge, Jorys
Background:
Antifibrinolytic medications, such as tranexamic acid, have
recently garnered increased attention. Despite its ability to mitigate
intraoperative blood loss and need for blood transfusion, there remains a
paucity of research in breast reconstruction. The authors investigate whether
intravenous tranexamic acid safely reduces the risk of hematoma following
implant-based breast reconstruction.
Methods:
A single-center
retrospective cohort study was performed to analyze all consecutive patients
undergoing immediate two-stage implant-based breast reconstruction following
mastectomy between 2015 and 2016. The incidence of postoperative hematomas and
thromboembolic events among all patients was reviewed. The patients in the
intervention group received 1000 mg of intravenous tranexamic acid before
mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher’s
exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic
regression models were performed to study the impact of intravenous tranexamic
acid after adjusting for possible confounders.
Results:
A total of 868 consecutive breast reconstructions (499
women) were reviewed. Overall, 116 patients (217 breasts) received intravenous
tranexamic acid, whereas 383 patients (651 breasts) did not. Patient
characteristics and comorbidities were similar between the two the groups.
Patients who received tranexamic acid were less likely to develop hematomas [n
= 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling
for age, hypertension, and type of reconstruction (prepectoral and subpectoral)
(p = 0.018). Adverse effects of intravenous tranexamic acid, including
thromboembolic phenomena were not observed. Multivariate analysis demonstrated
that age and hypertension independently increase risk for hematoma.
Conclusions:
Intravenous
tranexamic acid safely reduces risk of hematoma in implant-based breast
reconstruction. Further prospective randomized studies are warranted to further
corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
III.
