Published: 2022-07-26

Comparison of topical versus intravenous tranexamic acid on blood loss in modified radical mastectomy

Sumaira Nawaz, Muhammad Salman Shafique, Ghulam Khadija, Sayyam Fatima, Sadaf Nayab, Jahangir Sarwar Khan


Background: Modified radical mastectomy (MRM) is one of the surgical procedures for breast cancer management. Many complications are associated with wound healing, like hematoma, dehiscence, infection, chronic seroma and skin necrosis. The objective of this study was to compare the mean blood loss in drain output of topical versus intravenous tranexamic acid (TXA) use among patients undergoing modified radical mastectomy.

Methods: This randomized controlled trial was conducted at department of surgery, Holy Family hospital, Rawalpindi from November 2019 to November 2020. 130 patients were randomly divided into two groups. Group A patients received tranexamic acid topically while group B patients received intravenous tranexamic acid during modified radical mastectomy. Drain output and blood loss was recorded after twenty-four hours of the surgery.

Results: Mean age was 51.15±10.33 in group A, while it was 50.58±10.59 in group B. Mean duration of breast cancer among the patients was 11.45±8.70 months. Mean blood loss, 24 hours after MRM was 40.68±20.79 ml in the topical group, while it was 50.83±26.38 ml in the intravenous group (p=0.016).

Conclusions: Topical tranexamic acid showed significantly better control on blood loss as compared to intravenous TXA.


Modified radical mastectomy, Tranexamic acid, Blood loss

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Chen Z, Xu Y, Shu J, Xu N. Breast-conserving surgery versus modified radical mastectomy in treatment of early stage breast cancer: a retrospective study of 107 cases. J Cancer Res Ther. 2015;11(1):29-31.

Clegg-Lamptey JN, Dakubo JCB. Mastectomy blood loss: can we predict the need for blood transfusion? Int J Clin Med. 2014;5(20):1294-9.

Shang J, Wang H, Zheng B, Rui M, Wang Y. Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: a meta-analysis of randomized controlled trials. Int J Surg. 2016;36:324-9.

Yue C, Kang P, Yang P, Xie J, Pei F. Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty. 2014;29(12):2452-6.

Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am. 2014;96(23):1937-44.

Wang S, Gao X, An Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Int Orthop. 2017;41(4):739-48.

Wang H, Shen B, Zeng Y. Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective COHORT trials. Knee. 2014;21(6):987-93.

Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res. 2014;8(1):48-53.

Jansen AJ, Andreica S, Claeys M, D'Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999;83(4):596-601.

Heyns M, Knight P, Steve AK, Yeung JK. A single preoperative dose of tranexamic acid reduces perioperative blood loss: a meta-analysis. Ann Surg. 2021;273(1):75-81.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015;(6):007872.

Teoh WY, Tan TG, Ng KT, Ong KX, Chan XL, Tsan SE, et al. Prophylactic topical tranexamic acid versus placebo in surgical patients: a systematic review and meta-analysis. Ann Surg. 2021;273(4):676-83.

Lohani KR, Kumar C, Kataria K, Srivastava A, Ranjan P, Dhar A. Role of tranexamic acid in axillary lymph node dissection in breast cancer patients. Breast J. 2020;26(7):1316-20.

Albatanony AA, Assar AMA, Balshy MAE. Correlation between C-reactive protein, intravenous hydrocortisone, systemic tranexamic acid and post mastectomy seroma. Int Surg J. 2021;8(9):2544-52.

Knight H, Banks J, Muchmore J, Ives C, Green M. Examining the use of intraoperative tranexamic acid in oncoplastic breast surgery. Breast J. 2019;25(5):1047-9.

Ausen K, Hagen AI, Østbyhaug HS, Olafsson S, Kvalsund BJ, Spigset O, et al. Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial. BJS Open. 2020;4(2):216-24.

Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg. 2015;102(11):1348-53.

Eldesouky MS, Hady SAA, Mahmoud AS. Effect of topical application of tranexamic acid on reduction of wound drainage and seroma formation after mastectomy. Egypt J Surg. 2019;38(4):772-5.