Topical Tranexamic Acid Reduces Postoperative Drainage and Hematoma Rates in Soft Tissue Surgery Following a Standardized Surgical Protocol

BACKGROUND: Postoperative bleeding and prolonged drainage remain relevant complications in soft tissue surgery and may result in revision surgery, extended hospital stay, and increased morbidity. Topical tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic effects, has gained increasing attention as a means of reducing these complications while minimizing systemic exposure. However, standardized application protocols and robust outcome data remain limited. METHODS: This single-center retrospective cohort study included 241 consecutive patients undergoing gender-affirming mastectomy, breast reduction, or abdominoplasty between May 2020 and April 2024. In May 2022, a standardized topical TXA protocol (500 mg per surgical site) was implemented. Primary outcomes were cumulative drain output at 72 hours and postoperative hematoma requiring surgical revision. Secondary outcomes included seroma formation and postoperative complications. RESULTS: Topical TXA was administered in 93 patients (38.6%). Cumulative 72-hour drain output was lower in TXA-treated patients in every procedure, with the greatest relative reduction in abdominoplasty (-62%, P<0.001), followed by gender-affirming mastectomy (-51%, P=0.001) and reduction mammoplasty (-47%, P=0.005). Across all procedures, hematoma requiring surgical revision occurred in 6.5% (6/93) of TXA-treated patients compared with 15.5% (23/148) of controls, showing a relative risk reduction of 58% (P=0.042). No thromboembolic events, seizures, or wound-healing complications were observed. CONCLUSION: Topical TXA significantly reduces postoperative drainage and hematoma rates in soft tissue surgery without an observed increase in complications. Given its low cost and ease of application, topical TXA represents a valuable adjunct to standardized surgical protocols.