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Role of Tranexamic Acid (TXA) in Preventing Bleeding Following Sleeve Gastrectomy: a Systematic Review and Meta-analysis

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Abstract

Background

Tranexamic acid (TXA) has drawn growing interest over the last decade for its benefit in optimizing post-operative bleeding, yet its role in bariatric surgery is poorly understood.

Methods

The medical librarian developed and executed comprehensive searches on September 28, 2022. The population of interest included adults who underwent elective bariatric surgery. The intervention was tranexamic acid administration while the comparison was placebo or standard peri-operative therapy. The primary outcome of interest was post-operative bleeding which was defined a priori.

Results

A total of four studies were identified comprising of 475 patients. Of those, 207 (50%) received TXA at induction and all underwent laparoscopic sleeve gastrectomy (LSG). The majority of patients were female (n = 343, 80.7%) with ages ranging from 17 to 70 years of age and mean BMIs ranging from 37 to 56 kg/m2. Post-operative bleeding after LSG ranged from 0 to 28% depending on bleed definition and TXA administration with no differences in venous thromboembolic events or mortality between groups. Meta-analysis of post-operative bleeding demonstrated a statistically significant benefit with TXA administration (OR 0.40; 95% CI 0.23–0.70; p = 0.001) for patients undergoing elective LSG.

Conclusions

Intravenous tranexamic acid at the time of laparoscopic sleeve gastrectomy is associated with a significant reduction of post-operative bleeding with no observed differences in thromboembolic events or mortality. Further high-quality studies are needed to better delineate the ideal bariatric population to receives TXA in addition to the optimal timing, dose, and duration of TXA therapy.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Valentin Mocanu & Kevin Verhoeff

  2. Department of Medicine, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Hillary Wilson

  3. MLIS John W. Scott Health Sciences Library, University of Alberta, Mackenzie Health Sciences Centre, 2K3.28 Walter C, Edmonton, AB, Canada

    Janice Kung

  4. Center for Foregut, Bariatric, and Minimally Invasive Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Caolan Walsh, Nicole Koloszvari & Amy Neville

  5. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada

    Shahzeer Karmali

Authors
  1. Valentin Mocanu
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  2. Hillary Wilson
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  7. Amy Neville
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  8. Shahzeer Karmali
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Correspondence to Valentin Mocanu.

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Key Points

• Tranexamic acid (TXA) is an anti-fibrinolytic agent used to reduce bleeding following surgery.

• Meta-analysis demonstrated a significant reduction of post-operative sleeve bleeds in patients receiving TXA.

• There was no observed differences thromboembolic events or mortality associated with TXA.

• TXA was associated with over a half-fold decreased odds of bleeding after sleeve gastrectomy.

• TXA was not associated with increased thromboembolic events.

• Further bariatric studies are needed to delineate the optimal TXA dose and timing.

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Mocanu, V., Wilson, H., Verhoeff, K. et al. Role of Tranexamic Acid (TXA) in Preventing Bleeding Following Sleeve Gastrectomy: a Systematic Review and Meta-analysis. OBES SURG 33, 1571–1579 (2023). https://doi.org/10.1007/s11695-023-06563-w

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