Effect of topical tranexamic acid in reducing axillary drain output post modified radical mastectomy Surgery

Breast cancer is one of the most common cancer being diagnosed in women which accounts for more than 1 in 10 new cancer diagnosed every year. It is the second most common cause of death from cancer among women in the world. The most common procedure used at present is the modified radical mastectomy. One of the major complications associated with Modified radical mastectomy is seroma formation with the incidence rate reaching up to 18% which leads to delayed drain removal and increased hospital stay. Duration of surgery is directly associated with an increased risk of seroma formation. Factors like the level of lymph nodes and tumor size have been inconclusive in establishing an association with seroma formation. This study aims to study the role of tranexamic acid on this very common but important side effect of a very commonly performed surgery. Tranexamic acid is a synthetic derivative of lysine that blocks lysine binding sites on plasminogen which inhibits plasminogen thereby leading to reduced formation of plasmin. This leads to an overall reduction in fibrinolysis and reduction in blood loss. Seroma formation is related to local fibrinolytic activity, Being an anti-fibrinolytic, the local application of tranexamic acid looks promising in reducing seroma formation. Some studies have shown local application of tranexamic acid has equal efficacy as compared to IV administration for reduction in blood loss and better bone healing and granulation. The safety profile of Tranexamic acid remains in question due to a potential increased risk of venous thromboembolism. By applying TXA topically as opposed to intravenously, systemic absorption may be reduced and unwanted side effects mitigated. Tranexamic acid has immunomodulatory action independent of its action on plasminogen. This action of tranexamic acid can be correlated with surgical site infection rates. Tranexamic acid directly reduces fibrinolytic activity and hence modified radical mastectomy is a good choice of surgery to study the topical effect of Tranexamic acid.