Safety and clinical outcomes associated with the routine use of tranexamic acid (TXA) in abdominal-based free flap autologous breast reconstruction - a case control study

Background We present the clinical outcomes associated with the routine use of TXA in free flap breast reconstruction in a single unit. The primary outcome measures were thromboembolic events, hematoma, and seroma. The secondary outcome measure was the length of stay (LOS) of the patients. Methods Prospectively collected data of all free flap breast reconstruction performed by the senior author (GAA), where TXA was routinely used, were analyzed. Data were compared to a matched cohort in the same unit, prior to the introduction of TXA. Statistical analysis was performed. Results Between April 2018 and March 2020, 100 free flaps were performed on 81 females. The average BMI was 26.26 (range 19.5-32.5). The mean LOS was 3.5 days (range 3-8 days). Three patients (3.7%) were taken back to theaters. One patient had postoperative seroma and 4 flaps (4.9%) suffered minor fat necrosis. There were no cases of complete flap failure and no cases of DVT. The pre-TXA cohort, which included 95 consecutive flaps over the preceding 2 years period, had 2 cases of hematoma, three cases of seroma, and one case of DVT and PE. The TXA cohort had only one case of vessel thrombosis and no total flap loss compared to 4 cases of vessel thrombosis and 3 flap loss in the pre-TXA group. However, there was only a significant statistical difference in the LOS between the two groups favoring the TXA cohort. Conclusions Administration of TXA was neither associated with any DVT nor with a risk of pedicle thrombosis or flap loss, when compared to a pre-TXA cohort. Seroma rate (1%) in our cohort was low. The LOS was significantly lower than the pre-TXA cohort. This study highlights the safety of the routine use of TXA in the setting of free flap breast reconstruction.