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Intravenous Tranexamic Acid in Plastic Surgery Breast/Chest Procedures: A Single Surgeon Experience
James P. O'Brien, BS; David M. Turer, MD, MS; Isaac B. James, MD; Lorelei J. Grunwaldt, MD, FACS, FAAP
University of Pittsburgh Medical Center
2020-01-22
Presenter: James P. O'Brien
Affidavit:
I can confirm that this material proposed for presentation, or related work, has not been published or previously presented at a major meeting. I have reviewed this work and can confirm that it is the original work of the research team.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Goals/Purpose: Tranexamic acid (TXA) is an anti-fibrinolytic agent that has demonstrated promise as an intraoperative hemostatic agent. The efficacy and safety of tranexamic acid in plastic surgery patients remains unclear. This study investigates whether the use of intraoperative TXA is associated with a lower likelihood of post-operative complications.
Methods: A retrospective chart review of primary and revisionary breast/chest surgeries was performed. Patients either had not received TXA or had been given a bolus of TXA prior to incision followed by a maintenance infusion. Complications were analyzed between the two cohorts including hematoma, seroma, hypertrophic scarring, wound dehiscence, DVT/PE formation, re-operation, and infection.
Results: 271 charts were reviewed. 195 patients did not receive TXA and 76 patients received TXA. On average, patients who were given TXA received 3163±1076 mg (42.3±12.3 mg/kg). Patients who received TXA were less likely to experience a post-operative complication compared to those patients that did not receive TXA (7.9% vs. 22.1%). Patients in the TXA cohort were less likely to experience a postoperative infection (2.7% vs. 12.8%). There was no difference in hematoma, seroma, hypertrophic scarring, wound dehiscence, DVT/PE formation, and reoperation.
Conclusion: This study demonstrates that intravenous tranexamic acid is correlated with a lower likelihood of having any postoperative complication and specifically, a postoperative infection during breast/chest surgery. TXA administration is safe in patients undergoing breast/chest surgery and may help surgeons choose an appropriate dose. A prospective study to evaluate the efficacy of intravenous TXA in chest surgery is required to corroborate these findings.
