I love that we surgeons are always evolving. When doing a large surgery- like a breast cancer surgery where there is a mastectomy followed by a placement of breast implant or tissue expander- minimizing blood loss is important. Avoiding a hematoma (a collection of blood after surgery which may require a surgery to stop the bleeding) is important.
Enter antifibrinolytic medications. These are medications which help stop bleeding, hopefully lowering blood loss and the risk of hematoma. The question with these is do they cause other issues? And the big other issue we worry about is a blood clot in the leg or a pulmonary embolus, what we call “thromboembolic events.”
This study was in the September 2020 issue of Plastic and Reconstructive Surgery Journal. “IV Tranexamic Acid in Implant Based Breast Reconstruction Safely Reduces Hematoma without Thromboembolic Events.”
Study:
- Single center, retrospective study.
- Two groups: The intervention group got 1000 mg of IV tranexamic acid before mastectomy incision and 1000mg at the conclusion of the procedure.
- They had 868 consecutive breast reconstructions reviewed. 116 patients got the IV tranexamic acid, 383 patients did not.
- The two groups were similar in demographics.
Findings:
- Patients who had tranexamic acid were less likely to get hematomas 0.46% vs 2.9%
- There was no increased risk in thromboembolic events
- Analysis showed age and hypertension independently increased the risk for hematoma.
In the discussion, they call for a prospective randomized trial to clarify the efficacy and safety. There are over 150 randomized controlled trials in other surgical disciplines already. They feel the data in this article coupled with the large body of literature from other surgery disciplines are sufficient to justify its use in immediate breast reconstruction. They suggest it also may be good to prevent hematoma formation in other plastic surgical procedures like en bloc capsulectomy, where there is a large raw surface area.
My thoughts?
Interesting. This is not mainstream yet, but it seems promising. I don’t know the cost, availability, ideal use, or if there are any other issues with it. But I will follow this.