“Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion
of plasminogen to plasmin. TXA is also believed to have an anti-inflammatory effect and may improve platelet function under certain circumstances. TXA has increasingly gained recognition in perioperative use to mitigate the risk of postoperative bleeding. Originating in the field of anesthesiology, TXA is used to control surgical, traumatic, and postpartum hemorrhage. Meanwhile, perioperative TXA administration has been established in orthopedic and cardiothoracic surgery. It is also becoming popular in plastic surgery, especially regarding craniomaxillofacial procedures. Although the evidence on
the use of TXA in breast surgery is improving, its value still needs further investigation.”

“Although the absolute difference in postoperative hematoma and seroma rates was small
between the treatment groups, a statistically significant benefit could be attributed to perioperative TXA administration. Furthermore, although not always significant, there was a clear trend in favor of TXA administration in every included study.
Type of surgery in addition to timing and dosage of perioperative TXA administration var-
ied substantially between the different studies.
The exact surgery type regarding the extent of resection was addressed in only three studies.
Weissler et al. were the only authors differentiating mastectomy type and had significantly more skin-sparing than nipple-sparing mastectomies in the TXA group. However, this variable had no impact on the risk of hematoma formation in their cohort. Lohani et al. and Oertli et al. included patients who underwent either modified radical mastectomy, or breast-conserving surgery such as wide local excision or lumpectomy. The groups were reasonably well balanced in the study conducted by Lohani et al., whereas there were more radical mastectomies in the control group of Oertli et al. (59% versus 49%). When the data were pooled, lumpectomy patients accounted for 9.1% versus 4.7% in the TXA and control groups.”

Liechti, Rémy et al. “Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis.” Plastic and reconstructive surgery vol. 151,5 (2023): 949-957. Full Text for Emory Users