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Effect of Tranexamic Acid on Postoperative Bleeding in Sleeve Gastrectomy: a Randomized Trial

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Abstract

Purpose

Research on the timing and efficacy of tranexamic acid (TXA) use for perioperative bleeding in bariatric surgery is lacking. To evaluate the effects of TXA use on clinical outcomes in laparoscopic sleeve gastrectomy (LSG) by comparing TXA use at the beginning of induction with TXA use at the end of surgery and placebo use.

Materials and Methods

Between February 2022 and August 2022, 177 patients were randomized into three groups: TXA administered at the beginning of induction (TXAI), TXA administered at the end of surgery (TXAP), and placebo groups. Preoperative and postoperative care was standardized, and all patients received LSG. Analyzed using ANOVA, Mann-Whitney U test, and Student’s t-test.

Results

No significant difference was observed between the groups in terms of operative time and blood loss. There were significantly fewer intraoperative bleeding points in the TXAI group compared to the other groups (P < 0.05). Postoperative bleeding was significantly lower in the TXAI and TXAP groups compared to the placebo group (P < 0.05). Hemoglobin and CRP levels showed significant differences between the groups. TXA administration did not cause a significant decrease in coagulation values, and there were no cases of venous thromboembolism (VTE) during the follow-up period.

Conclusion

This study provides evidence that TXA administered during LSG is effective in reducing postoperative bleeding. No data were obtained regarding the superiority of TXA administration at the beginning of induction and at the end of surgery.

Trial Registration

ClinicalTrials.gov with the registration code NCT05696951, 25 January 2023: https://www.clinicaltrials.gov/study/NCT05696951.

Graphical Abstract

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Data Availability

Data available upon request from corresponding authors.

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Acknowledgements

Our sincere thanks to Prof. Remzi Kiziltan and Dr. Cemil Binarbasi for their efforts in the preparation and design of this article.

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Authors and Affiliations

  1. Department of General Surgery, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Dr. Erkin Street No:3, 34732 Kadikoy, Istanbul, Turkey

    Medeni Sermet & Mehmet Sait Ozsoy

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  1. Medeni Sermet
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Contributions

Medeni Sermet: software; validation; formal analysis; investigation; resources; data curation; writing—original draft; writing—review and editing

Mehmet Sait Özsoy: visualization, supervision, project administration, formal analysis, data curation, resources

Corresponding author

Correspondence to Medeni Sermet.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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The authors have read and approved the manuscript in all respects for publication.

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The authors declare no competing interests.

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Textual Abstracts

• TXA administration is effective in sleeve gastrectomy surgeries.

• There is no between administration of TXA at the beginning of induction or at the end of surgery.

• TXA should be used in selected patients with high bleeding potential in sleeve gastrectomy.

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Sermet, M., Ozsoy, M.S. Effect of Tranexamic Acid on Postoperative Bleeding in Sleeve Gastrectomy: a Randomized Trial. OBES SURG 33, 3962–3970 (2023). https://doi.org/10.1007/s11695-023-06902-x

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