Does Topical Tranexamic Acid Facilitate Faster Discharge Following Lung Resection? A Retrospective Cohort Analysis

Background/Objectives: Managing postoperative drainage and reducing the length of hospital stays continue to represent significant challenges in thoracic surgery. While systemic antifibrinolytics are effective, concerns persist regarding neurotoxicity and thromboembolic risks. In this study, we evaluated the efficacy and safety of a unique, high-volume topical tranexamic acid (t-TXA) lavage protocol designed to optimize pleuroparenchymal contact and stabilize local hyperfibrinolysis. Methods: A retrospective comparative study was conducted involving 52 patients undergoing major lung resection, divided into a t-TXA group (n = 26) and a control group (n = 26). The t-TXA group received an intrathoracic lavage consisting of 5 g of tranexamic acid (TXA) diluted in 500 mL of saline, while the control group received 500 mL of saline alone. The primary outcomes included postoperative day (POD) 1 drainage volumes and length of stay (LOS). The secondary outcomes were focused on hematological parameters and safety profiles, including a structured one-year follow-up for all patients. Due to the study's exploratory nature, primary outcomes were assessed using 95% confidence intervals for hypothesis generation rather than a priori sample size calculations. Results: No significant differences were observed between groups regarding sex, surgical approach, or resection type. The t-TXA group demonstrated a significantly shorter LOS (4.20 ± 1.23 days) compared to the control group (5.88 ± 2.23 days; p = 0.001). While POD 1 drainage was numerically lower in the t-TXA group (189.23 ± 235.06 mL) versus the control (284.23 ± 169.40 mL), this difference did not reach statistical significance (p = 0.101). However, exploratory correlation analysis revealed a moderate negative association between t-TXA application and POD 1 drainage (r = -0.412; p = 0.002). Postoperative platelet counts were significantly lower in the t-TXA group (p = 0.009). No thromboembolic events, late complications, or deaths occurred in either group during the one-year follow-up period. Conclusions: High-volume t-TXA lavage is a promising adjuvant associated with significantly shorter hospital stays and a trend toward reduced postoperative drainage. While our 12-month follow-up confirmed a favorable safety profile with no adverse events, these findings should be interpreted as preliminary and hypothesis-generating. The retrospective nature of this study precludes definitive recommendations, underscoring the need for well-powered prospective randomized trials to establish the long-term safety and clinical utility of t-TXA in thoracic surgery.