Randomized clinical trial of topical tranexamic acid after reduction mammoplasty.
BACKGROUND
The antifibrinolytic drug tranexamic acid is currently being rediscovered for both trauma and major surgery. Intravenous administration reduces the need for blood transfusion and blood loss by about one-third, but routine administration in surgery is not yet advocated owing to concerns regarding thromboembolic events. The aim of this study was to investigate whether topical application of tranexamic acid to a wound surface reduces postoperative bleeding.


METHODS
This was a randomized double-blind placebo-controlled trial on 30 consecutive women undergoing bilateral reduction mammoplasty. On one side the wound surfaces were moistened with 25 mg/ml tranexamic acid before closure, and placebo (saline) was used on the other side. Drain fluid production was measured for 24 h after surgery, and pain was measured after 3 and 24 h. Postoperative complications including infection, seroma, rebleeding and suture reactions were recorded.


RESULTS
Topical application of tranexamic acid to the wound surface after reduction mammoplasty reduced drain fluid production by 39 per cent (median 12·5 (range 0-44) versus 20·5 (0-100) ml; P = 0·038). Adverse effects were not observed. There were no significant differences in postoperative pain scores or complications.


CONCLUSIONS
Topical application of dilute tranexamic acid reduced bleeding in this model. The study adds to the evidence that this simple procedure may reduce wound bleeding after surgery.


BACKGROUND
NCT01964781 ( http://www.clinicaltrials.gov).
Departments of Plastic and Reconstructive Surgery, St Olav's University Hospital, Trondheim, Norway.
K
K
Ausen
Departments of Internal Medicine, St Olav's University Hospital, Trondheim, Norway.|Departments of Cancer Research and Molecular Medicine, Children's and Women's Health, Trondheim, Norway.
R
R
Fossmark
Departments of Clinical Pharmacology, St Olav's University Hospital, Trondheim, Norway.|Departments of Laboratory Medicine, Children's and Women's Health, Trondheim, Norway.
O
O
Spigset
Clinic of Anaesthesia and Intensive Care, St Olav's University Hospital, Trondheim, Norway.|Departments of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
H
H
Pleym
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid