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Background <p>Post-surgical blood loss increases mortality risk and often necessitates transfusion, adding to healthcare costs. Tranexamic Acid (TXA), an antifibrinolytic agent, is widely used in trauma and orthopedic surgery without a demonstrated rise in thromboembolic events. However, limited data exist on its safety in oncologic breast reconstruction. This study evaluates the safety of intravenous (IV) TXA in patients undergoing breast reconstruction after mastectomy, focusing on rates of hematoma, seroma, and time to drain removal.</p> Methods <p>A retrospective review included 316 patients who underwent autologous or implant-based breast reconstruction. Of these, 54 received perioperative IV TXA and 262 served as controls. Postoperative complications within 30 days were recorded, including hematoma, seroma, infection, minor complications, thromboembolic events, and reoperations.</p> Results <p>Across all patients, 60 complications (16.7%) occurred. Two pulmonary emboli were identified—one in a TXA patient and one in a non-TXA patient—both with significant preexisting risk factors, including prior DVT, age over 60, BMI &gt; 35, smoking, hypertension, and diabetes. Minor complications occurred in 20 patients (9.2%). Overall, 18 patients (5.7%) developed hematomas, 10 (3.2%) developed seromas, and 19 (6.0%) had infections. Mean total drain duration was 17.6 days (SD 10.3), with no significant difference between groups. Binomial regression indicated increased odds of complications in patients with prior antiplatelet use (OR 2.49, <i>p</i> = 0.0523), though this did not reach statistical significance.</p> Conclusions <p>IV TXA use did not significantly affect complication rates or drain duration, suggesting it is relatively safe during oncologic breast reconstruction. The study was underpowered to assess thromboembolic risk, and TXA dosing effects were not evaluated. Level of Evidence: Level III, risk / prognostic study.</p>

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Intravenous tranexamic acid use in breast reconstruction: a retrospective study at a high-volume breast center

  • 期刊论文

  • 发表日期：

    2026年5月25日

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  • Alexa Clark,
  • Orr Shauly,
  • Julianna Zeepvat,
  • Albert Losken,
  • Abdl-Rawf Al-Nowaylati,
  • Gabriela Garcia Nores

摘要

Background

Post-surgical blood loss increases mortality risk and often necessitates transfusion, adding to healthcare costs. Tranexamic Acid (TXA), an antifibrinolytic agent, is widely used in trauma and orthopedic surgery without a demonstrated rise in thromboembolic events. However, limited data exist on its safety in oncologic breast reconstruction. This study evaluates the safety of intravenous (IV) TXA in patients undergoing breast reconstruction after mastectomy, focusing on rates of hematoma, seroma, and time to drain removal.

Methods

A retrospective review included 316 patients who underwent autologous or implant-based breast reconstruction. Of these, 54 received perioperative IV TXA and 262 served as controls. Postoperative complications within 30 days were recorded, including hematoma, seroma, infection, minor complications, thromboembolic events, and reoperations.

Results

Across all patients, 60 complications (16.7%) occurred. Two pulmonary emboli were identified—one in a TXA patient and one in a non-TXA patient—both with significant preexisting risk factors, including prior DVT, age over 60, BMI > 35, smoking, hypertension, and diabetes. Minor complications occurred in 20 patients (9.2%). Overall, 18 patients (5.7%) developed hematomas, 10 (3.2%) developed seromas, and 19 (6.0%) had infections. Mean total drain duration was 17.6 days (SD 10.3), with no significant difference between groups. Binomial regression indicated increased odds of complications in patients with prior antiplatelet use (OR 2.49, p = 0.0523), though this did not reach statistical significance.

Conclusions

IV TXA use did not significantly affect complication rates or drain duration, suggesting it is relatively safe during oncologic breast reconstruction. The study was underpowered to assess thromboembolic risk, and TXA dosing effects were not evaluated. Level of Evidence: Level III, risk / prognostic study.