From the Division of Plastic Surgery.
Michael G. DeGroote School of Medicine, McMaster University.
Plast Reconstr Surg. 2023 Dec 1;152(6):993e-1004e. doi: 10.1097/PRS.0000000000010479. Epub 2023 Mar 30.
Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study was to determine the effect of TXA on postoperative blood loss in breast surgery.
Searches of the PubMed, Ovid MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized controlled trials that administered TXA (topical or intravenously) in the context of breast surgery. Quality of studies were evaluated using the risk of bias in randomized trials tool and the risk of bias in nonrandomized studies of interventions tool. Data were pooled, and a meta-analysis was performed.
In total, seven studies were included, representing 1226 patients (TXA, 632 patients; control, 622 patients). TXA was administered as follows: topically (20 mL of 25 mg/mL TXA intraoperatively; n =258 patients), intravenously (1 to 3 g perioperatively; n = 743 patients), or both (1 to 3 g daily up to 5 days postoperatively; n = 253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI, 0.32 to 0.73), with no effect on drain output (mean difference, -84.12 mL; 95% CI, -206.53 to 38.29 mL), seroma formation (risk ratio, 0.92; 95% CI, 0.60 to 1.40), or infection rates (risk ratio, 1.01; 95% CI, 0.46 to 2.21). No adverse effects were reported.
The use of TXA in breast surgery is a safe and effective modality with low-level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.
氨甲环酸（TXA）在创伤和外科环境中使用。它在减少乳房手术后失血方面的作用尚不清楚。本研究的主要目的是确定 TXA 对乳房手术后失血的影响。
从建库至 2020 年 4 月 3 日，对 PubMed、Ovid MEDLINE、Embase、CINAHL 和 Cochrane 对照试验中心注册库进行了检索。纳入标准为任何回顾性综述、前瞻性队列研究和随机对照试验，这些研究在乳房手术中给予 TXA（局部或静脉内）。使用随机试验偏倚风险工具和干预措施非随机研究偏倚风险工具评估研究质量。对数据进行汇总并进行荟萃分析。
共纳入 7 项研究，共 1226 例患者（TXA 组 632 例，对照组 622 例）。TXA 的给药方式如下：局部（术中给予 20 mL 25 mg/mL TXA，n =258 例）、静脉内（围手术期给予 1 至 3 g，n =743 例）或两者（术后每天给予 1 至 3 g，最多 5 天，n =253 例）。TXA 给药可减少乳房手术中的血肿形成（风险比，0.48；95%CI，0.32 至 0.73），但对引流量（平均差，-84.12 mL；95%CI，-206.53 至 38.29 mL）、血清肿形成（风险比，0.92；95%CI，0.60 至 1.40）或感染率（风险比，1.01；95%CI，0.46 至 2.21）无影响。未报告不良反应。
在乳房手术中使用 TXA 是一种安全有效的方法，低水平证据表明它可降低血肿发生率，而不影响血清肿发生率、术后引流量或感染率。
