From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science.
Plast Reconstr Surg. 2020 Aug;146(2):238-245. doi: 10.1097/PRS.0000000000006967.
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.
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.
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.
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.
抗纤维蛋白溶解药物，如氨甲环酸，最近受到了越来越多的关注。尽管它能够减少术中失血量和输血需求，但在乳房重建方面的研究仍然很少。作者研究了静脉注射氨甲环酸是否能安全降低乳房重建术后血肿的风险。
对 2015 年至 2016 年间接受乳房切除术即刻行两阶段植入物乳房重建的所有连续患者进行了单中心回顾性队列研究。回顾了所有患者的术后血肿和血栓栓塞事件发生率。干预组患者在乳房切除术切口前接受 1000mg 静脉注射氨甲环酸，手术结束时接受 1000mg。采用 Fisher 确切检验和 Mann-Whitney-Wilcoxon 检验。进行多变量逻辑回归模型分析，以调整可能的混杂因素后研究静脉注射氨甲环酸的影响。
共回顾了 868 例连续乳房重建术（499 例女性）。总体而言，116 例（217 侧乳房）患者接受了静脉注射氨甲环酸，383 例（651 侧乳房）患者未接受。两组患者的特征和合并症相似。在控制年龄、高血压和重建类型（胸肌前和胸肌下）后，接受氨甲环酸的患者血肿发生率较低[n=1（0.46%）]，而未接受氨甲环酸的患者血肿发生率较高[n=19（2.9%）]（p=0.018）。未观察到静脉注射氨甲环酸的不良反应，包括血栓栓塞现象。多变量分析表明，年龄和高血压独立增加血肿的风险。
静脉注射氨甲环酸可安全降低植入物乳房重建术后血肿的风险。需要进一步的前瞻性随机研究来进一步证实这些发现。
临床问题/证据水平：治疗性，III 级。
