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Effect of Tranexamic Acid in Reducing Seroma Formation and Drain Output After Modified Radical Mastectomy: A Double
Furqan Mohammed Ahmed1, Gomathi Shankar1, Ankit Jain1
1Department of General Surgery, Jipmer, Puducherry, India.
Abstract:
Seroma and high drain output is common complication after modified radical mastectomy (MRM). MRM leaves behind a negative space which fills up with fluid from cut lymphatics and tissue leading to seroma. Tranexamic acid decreases clot degradation thereby plugging the vessels leading to decreased seroma. This study is to determine if tranexamic acid reduces the incidence of seroma formation, drain output, and wound-related complications in post-operative cases of MRM. We conducted a prospective, double blinded, parallel arm, randomized control trial of 160 women with breast cancer undergoing MRM to study the effect of tranexamic in reducing seroma and drain output. Patients were recruited from a period of 2021-2022. Tranexamic acid was given 15 mg/kg IV at the time of administration of anaesthesia and 500 mg twice a day for 5 days with the control group receiving a placebo. The cases were followed up for a period of one month. Drain output, clinical seroma formation, and wound-related complications were recorded. There was a significant reduction in the drain output compared to the patients receiving a placebo (590 ml vs 725 ml: p = 0.001). The number of patients developing a clinically detectable seroma was also reduced (16.3% vs 31.3%: p = 0.025). Tranexamic acid also led to reduction in wound infection (6.3% vs 23.8%: p = 0.002). Wound dehiscence and flap necrosis was also lower in the tranexamic acid group, but it was not statistically significant. Our results show that tranexamic acid reduces seroma formation, facilitates early drain removal, and reduces the wound infection in patients undergoing MRM.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s13193-024-02050-5.
Insights
Tranexamic acid significantly reduced seroma formation and drain output after mastectomy. This antifibrinolytic agent also lowered wound infection rates in patients undergoing modified radical mastectomy (MRM).
Area of Science:
- Oncology
- Surgical Innovation
- Pharmacology
Background:
- Seroma and high drain output are frequent complications following modified radical mastectomy (MRM).
- These complications arise from fluid accumulation in the surgical space created by MRM.
- Tranexamic acid, an antifibrinolytic agent, may reduce seroma by stabilizing clots and minimizing bleeding.
Purpose of the Study:
- To evaluate the efficacy of tranexamic acid in reducing seroma formation post-MRM.
- To assess the impact of tranexamic acid on drain output and wound-related complications.
- To determine if tranexamic acid facilitates earlier drain removal after MRM.
Main Methods:
- A prospective, double-blinded, randomized controlled trial involving 160 women undergoing MRM.
- Patients received either tranexamic acid (15 mg/kg IV at anesthesia + 500 mg twice daily for 5 days) or a placebo.
- Outcomes including drain output, seroma formation, and wound complications were monitored for one month.
Main Results:
- Significantly lower drain output in the tranexamic acid group compared to placebo (590 ml vs 725 ml, p=0.001).
- Reduced incidence of clinically detectable seroma in the tranexamic acid group (16.3% vs 31.3%, p=0.025).
- Lower rates of wound infection (6.3% vs 23.8%, p=0.002) and a trend towards less wound dehiscence and flap necrosis.
Conclusions:
- Tranexamic acid effectively reduces seroma formation and drain output after modified radical mastectomy.
- The use of tranexamic acid is associated with a significant decrease in post-operative wound infections.
- Tranexamic acid shows promise in improving recovery outcomes for patients undergoing MRM.
