SEroma Reduction pOst MAstectomy "SEROMA Study"

NCT ID: NCT03738527

Last Updated: 2021-02-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-07

Study Completion Date

2022-07-31

Brief Summary

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This is a pilot study to evaluate the feasibility of conducting a larger trial to determine if the use of intraoperative topical tranexamic acid (TXA) decreases the rate of post-operative hematomas and seromas in breast cancer patients after their mastectomy. In other words, the investigators want to determine if applying TXA inside the surgical wound before it is closed helps reduce blood or serous fluid accumulation at the operative site. Dependent on the results of this study, a further larger trial may or may not take place.

Post-operative seromas and hematomas are common complications of mastectomy surgery not only leading to infection, discomfort, wound dehiscence or emergency room visits; they also delay in some instances post-operative adjuvant radiotherapy. Establishing whether or not topical TXA is an effective strategy to decrease those complications can potentially impact positively the breast cancer treatment.

To achieve this aim, this randomized pilot study will first determine whether a larger multicenter study if feasible. This study will replicate a formal randomized trial at a smaller scale in a single center in order to assess the recruitment and randomization process, as well as provide preliminary results for our research question.

Detailed Description

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The objective of this study is to investigate the novel use of topical application of Tranexamic Acid (TXA) to the surgical wound as a means to decrease seroma and/or hematoma formation compared to placebo in post-mastectomy patients. This project is designed as a single-center pilot RCT to evaluate the feasibility of conducting a formal RCT (multicenter trial including more patients) to evaluate the effectiveness of topical TXA.

Patients will be randomly assigned to one of two treatment groups for intraoperative treatment of their mastectomy wound before it is closed.

The first group will consist of those who will be treated with the intravenous form of TXA that will be applied to the surface of the mastectomy wound area rather than being injected into a vein. The second group consists of those individuals who will be treated with a topical normal saline solution (a placebo, or inactive substance that looks identical to the study drug but contains no therapeutic ingredients).

Both groups will receive the same number of drains and the same post-operative follow-up schedule consisting of visits 2 to 4 weeks and 3 months after the surgery, as well as a last 12 months follow-up. Standard of care will be practiced with respect to all procedures and visits.

Conditions

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Seroma Complicating A Procedure Hematoma Postoperative Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Pilot Randomized Controlled Trial (RCT) with 2 arms: the interventional arm (receiving topical TXA) and the control arm (receiving placebo).

Intervention: Topical application of 20 mL of TXA (100 mg/mL injection solution) to the mastectomy cavity

Placebo: Topical application of 20 mL of 0.9% NaCl (normal saline) to the mastectomy cavity
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Caregivers
Patients will be randomized on the REDCap system. Their assignment will be made available to pharmacy, which will be prepare syringes with either TXA or placebo.

Study Groups

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TXA arm

Group Type EXPERIMENTAL

Tranexamic Acid 100mg/mL, 20mL topical

Intervention Type DRUG

Drug: Tranexamic Acid

20 mL TXA (100 mg/mL injection solution, total 2g TXA) applied topically to the mastectomy cavity for 5 minutes before wound closure

Placebo arm

Group Type PLACEBO_COMPARATOR

Normal Saline Flush, 0.9%, 20mL topical

Intervention Type DRUG

Drug: Normal Saline

20 mL 0.9% NaCl (normal saline) applied topically to the mastectomy cavity for 5 minutes before wound closure

Interventions

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Tranexamic Acid 100mg/mL, 20mL topical

Drug: Tranexamic Acid

20 mL TXA (100 mg/mL injection solution, total 2g TXA) applied topically to the mastectomy cavity for 5 minutes before wound closure

Intervention Type DRUG

Normal Saline Flush, 0.9%, 20mL topical

Drug: Normal Saline

20 mL 0.9% NaCl (normal saline) applied topically to the mastectomy cavity for 5 minutes before wound closure

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Breast cancer diagnosis
* Age 18-80
* Fluent in English
* Female undergoing mastectomy with or without axillary intervention

Exclusion Criteria

* Immediate reconstruction
* Pre-surgical radiation
* Known allergy to TXA
* Known thromboembolic disease
* High-risk of thromboembolism and/or receiving anticoagulants
* History of myocardial infarction (MI), transient ischemic attack or stroke within the last year
* History of subarachnoid hemorrhage
* Premenopausal women with irregular menstrual bleeding of unknown cause
* Acquired disturbances of colour vision
* Hematuria with renal cause
* History of seizure disorder
* Pregnant or breastfeeding
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Hamilton Health Sciences Corporation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nicole Hodgson, MD, MSc, FRCSC

Role: PRINCIPAL_INVESTIGATOR

Hamilton Health Sciences, McMaster University

Locations

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St. Joseph's Healthcare Hamilton

Hamilton, Ontario, Canada

Site Status RECRUITING

Juravinski Hospital - Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Isabelle Duchesnay, M.D.

Role: CONTACT

905-521-2100 ext. #4843

References

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Porter KA, O'Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998 Jul;176(1):8-11. doi: 10.1016/s0002-9610(98)00093-2.

Reference Type BACKGROUND
PMID: 9683123 (View on PubMed)

Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surg Oncol. 2003 Nov;29(9):711-7. doi: 10.1016/s0748-7983(03)00096-9.

Reference Type BACKGROUND
PMID: 14602488 (View on PubMed)

van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surg Oncol. 2011 Oct;37(10):829-35. doi: 10.1016/j.ejso.2011.04.012. Epub 2011 Aug 17.

Reference Type BACKGROUND
PMID: 21849243 (View on PubMed)

Coveney EC, O'Dwyer PJ, Geraghty JG, O'Higgins NJ. Effect of closing dead space on seroma formation after mastectomy--a prospective randomized clinical trial. Eur J Surg Oncol. 1993 Apr;19(2):143-6.

Reference Type BACKGROUND
PMID: 8491318 (View on PubMed)

Baker E, Piper J. Drainless mastectomy: Is it safe and effective? Surgeon. 2017 Oct;15(5):267-271. doi: 10.1016/j.surge.2015.12.007. Epub 2016 Feb 19.

Reference Type BACKGROUND
PMID: 26907221 (View on PubMed)

He XD, Guo ZH, Tian JH, Yang KH, Xie XD. Whether drainage should be used after surgery for breast cancer? A systematic review of randomized controlled trials. Med Oncol. 2011 Dec;28 Suppl 1:S22-30. doi: 10.1007/s12032-010-9673-2. Epub 2010 Sep 9.

Reference Type BACKGROUND
PMID: 20827578 (View on PubMed)

Ker K, Roberts I, Shakur H, Coats TJ. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2015 May 9;2015(5):CD004896. doi: 10.1002/14651858.CD004896.pub4.

Reference Type BACKGROUND
PMID: 25956410 (View on PubMed)

Gupta K, Rastogi B, Krishan A, Gupta A, Singh VP, Agarwal S. The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study. Anesth Essays Res. 2012 Jan-Jun;6(1):70-3. doi: 10.4103/0259-1162.103378.

Reference Type BACKGROUND
PMID: 25885506 (View on PubMed)

Perel P, Ker K, Morales Uribe CH, Roberts I. Tranexamic acid for reducing mortality in emergency and urgent surgery. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD010245. doi: 10.1002/14651858.CD010245.pub2.

Reference Type BACKGROUND
PMID: 23440847 (View on PubMed)

Oertli D, Laffer U, Haberthuer F, Kreuter U, Harder F. Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer. Br J Surg. 1994 Jun;81(6):856-9. doi: 10.1002/bjs.1800810621.

Reference Type BACKGROUND
PMID: 8044602 (View on PubMed)

Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev. 2013 Jul 23;2013(7):CD010562. doi: 10.1002/14651858.CD010562.pub2.

Reference Type BACKGROUND
PMID: 23881695 (View on PubMed)

Xu X, Xiong S, Wang Z, Li X, Liu W. Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials. Drug Discov Ther. 2015 Jun;9(3):173-7. doi: 10.5582/ddt.2015.01018.

Reference Type BACKGROUND
PMID: 26193938 (View on PubMed)

Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg. 2015 Oct;102(11):1348-53. doi: 10.1002/bjs.9878.

Reference Type BACKGROUND
PMID: 26349843 (View on PubMed)

Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2014 Nov 21;2014(11):CD006640. doi: 10.1002/14651858.CD006640.pub3.

Reference Type BACKGROUND
PMID: 25414987 (View on PubMed)

Other Identifiers

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5271

Identifier Type: -

Identifier Source: org_study_id

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