• K Ausen, R Fossmark, O Spigset, and H Pleym.
• Departments of Plastic and Reconstructive Surgery, St Olav's University Hospital, Trondheim, Norway.
• Br J Surg. 2015 Oct 1; 102 (11): 1348-53.

BackgroundThe 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.MethodsThis 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.ResultsTopical 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.ConclusionTopical 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.Registration NumberNCT01964781 ( http://www.clinicaltrials.gov).© 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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