Efficacy of Aminocaproic Acid in Preventing Postoperative Hematoma in Breast Cancer Surgery: A Prospective Study.

[BACKGROUND AND OBJECTIVES] Hemorrhage after oncologic breast surgery occurs in up to 11% of cases, remaining the leading cause of reoperation. Although antifibrinolytics are widely used in other surgical settings, their role in oncologic breast surgery is not well established. This study evaluated the efficacy and safety of aminocaproic acid (ACAc) in reducing postoperative hematoma following oncological mastectomies.

[METHODS] A prospective randomized study was conducted between July 2020 and May 2022, including women ≥ 18 years old undergoing mastectomy. Patients were randomized into three groups: (A) topical application of 5 g of ACAc; (B) intravenous 2.5 g administered 30 min before incision; and (C) no treatment (control). Statistical tests included ANOVA, Chi-square, and multivariable regression.

[RESULTS] A total of 166 patients were enrolled. Postoperative hematoma occurred in 3.6% of patients in group A, 1.8% patients in group B, and 12.7% in the control. Multivariable logistic regression demonstrated a protective effect of intravenous ACAc compared with control (p = 0.021). No differences in reoperation rates were observed. No thromboembolic events nor hepatic or renal toxicity occurred. Hypertension was identified as an independent risk factor for postoperative hematoma.

[CONCLUSIONS] Intravenous ACAc reduces postoperative hematoma in oncologic mastectomy and may represent a low-cost, effective adjunct to bleeding prevention in this setting.