Thoughts on: Efficacy of Tranexamic Acid in Reducing Seroma and Hematoma Formation Following Reduction Mammaplasty

We read with great interest the article entitled “Efficacy of Tranexamic Acid in Reducing Seroma and Hematoma Formation Following Reduction Mammaplasty.” ¹ The antifibrinolytic drug tranexamic acid (TXA) reduces bleeding in patients undergoing surgery and is often utilized in patients at high risk for blood loss in surgical subspecialties.^2-4 The authors investigate the value of TXA in reduction mammaplasty, and the results show no reduction in risk when utilizing TXA in reducing seroma and hematoma.

We have a question about this study. The authors stated “Based on the promising results in this patient cohort, its use was expanded to breast reductions in June 2018 . . . and TXA is now used consistently for all reduction mammaplasties.” The included patients underwent reduction mammaplasty between January 2016 and July 2021, so does that mean that before June 2018, none of the patients utilized TAX and after that all patients utilized TAX? Is there a period during which surgeons (the operating surgeon or resident) choose to utilize TAX according to the specific situation of the patients?

This question is very important. We found a significant difference in the mean resection weight per breast among the TXA and no-TXA cohorts, and we all know that the increase in resection weight was significantly associated with an increased risk of bleeding. We tend to utilize hemostatic drugs in those patients who have more risk of losing blood in clinical practice. It is impossible to infer whether it is effective due to the deviation caused by artificial selection. It is necessary to explain how to distinguish the 2 groups of patients and whether it is a randomized control. We admire the efforts made by the authors, and we hope the authors could reply as a supplement to the original article to enhance its reference value.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

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