Effects of tranexamic acid in patients undergoing liver surgeries: an updated meta-analysis of randomized-controlled trials.

Perioperative bleeding is a significant concern in hepatic surgeries, leading to increased morbidity, blood transfusions, and associated risks. Tranexamic acid (TXA) is effective in reducing blood loss in various surgical procedures, but its efficacy in liver surgeries remains uncertain. PubMed, CENTRAL, Web of Science, Embase, and Scopus were systematically searched without any automated filters through 20th October 2024. Continuous data were reported in mean difference (MD) with 95% confidence interval (95% CI), and dichotomous data were reported in odds ratio (OR) with 95% CI. STATA Corp M17 was used to analyze our outcomes. Six RCTs were analyzed, including 1,618 patients undergoing liver surgeries (resections or transplants). TXA did not significantly reduce the need for postoperative blood transfusion (OR 0.72; 95% CI [0.35-1.47], p = 0.37; I2 = 52.9%). TXA also showed no significant effect on intraoperative RBC units (MD - 1.31; 95% CI [-3.41 to 0.78], p = 0.22; I2 = 72.14%). No increased risk of thrombotic events (OR 1.68; 95% CI [0.98-2.88], p = 0.06; I2 = 0%) or mortality (OR 1.05; 95% CI [0.57-1.91], p = 0.88; I2 = 0%) was observed. TXA did not significantly reduce blood loss or hospital stay duration. TXA demonstrates no significant benefit in reducing perioperative bleeding or transfusion requirements in hepatic surgeries. It might be safe, with no increased thrombotic risk, but its clinical utility in this surgical context remains questionable. Further large-scale RCTs are needed to clarify its role in liver surgeries.