The current state of tranexamic acid in mastectomy and breast reconstruction: A systematic review and meta-analysis

Background: The use of tranexamic acid (TXA) in breast surgery has been increasing; however, there have been no recent studies synthesizing the most current data. The purpose of this study was to perform a comprehensive targeted analysis on the impact of TXA in mastectomy with and without breast reconstruction. Methods: A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analysis guidelines. Five databases were queried to identify studies using TXA in breast surgery. Dual-screening was employed to identify studies on mastectomy with and without breast reconstruction for full-text evaluation. Outcomes assessed included postoperative hematoma, seroma, surgical site infection (SSI), drain output, and drain duration. Data were pooled, and meta-analysis was performed. Odds ratios (OR) and mean differences (MD) were reported via the Mantel-Haenszel and Inverse-Variance methods, respectively. Results: Thirteen studies totaling 2115 patients were included, with 44% of the patients (n=926) receiving TXA. Overall, 83% of the patients (n=772) received TXA intraoperatively and 82% of (n=632) received intravenous administration. Postoperative hematoma occurred in 2.4% of the patients (n=18) in the TXA group compared to 5.5% of the patients (n=53) in the control group, representing 60% decreased odds (OR 0.40; 95% CI [0.23-0.70], P = 0.001) of hematoma formation. TXA administration significantly reduced drain duration and 24-hour drain output by 1.2 days and 41.8 mL, respectively (MD: -1.2; P = 0.03; MD: -41.8; P = 0.002). TXA administration did not significantly impact the rates of seroma formation or SSI.