Prophylactic Tranexamic Acid as Prevention for Early Postoperative Bleeding after Roux-en-Y Gastric Bypass.

BACKGROUND

Postoperative bleeding (POB) after Roux-en-Y gastric bypass (RYGB) occurs in up to 4.1% of cases and is associated with increased 30-day mortality, transfusions, and reinterventions.

METHODS

This study evaluated whether tranexamic acid (TXA) administered during anesthetic induction reduces clinical POB within 48 h after primary laparoscopic RYGB. Secondary outcomes included risk factors for POB, thromboembolic events (TEE), and mortality. In this mixed cohort study, consecutive patients undergoing RYGB between 2020 and 2025 were divided according to systematic TXA use.

RESULTS

Among 678 patients, 347 (51.2%) received TXA. This group’s mean age was 37 years and their mean BMI 40.4 kg/m². POB occurred in 21 patients (3.1%). TXA significantly reduced POB risk (OR 4.25; p = 0.007). Being of male sex increased POB risk (OR 2.59; p = 0.031). No differences in TEE or mortality were observed.

CONCLUSIONS

TXA reduced POB risk by 70–78%. It was also noted that male sex was an independent risk factor.