Tranexamic acid in laparoscopic sleeve gastrectomy: bleeding control amid thrombotic concerns and hemodynamic instability: a randomized double-blinded clinical trial.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) carries a risk of intraoperative and postoperative bleeding. Tranexamic acid (TXA) has been proposed to reduce blood loss. We evaluated the efficacy of TXA in preventing perioperative bleeding in patients undergoing LSG.

METHODS

In a randomized clinical trial, 185 morbidly obese patients scheduled for elective LSG were randomly assigned to receive TXA (n = 93) or a placebo (n = 92) before surgery. The rate of bleeding requiring blood transfusion, 24-hour serum hemoglobin levels, postoperative hemodynamic indices, and the incidence of postoperative thrombotic events were assessed.

RESULTS

Intraoperative bleeding occurred less frequently in the TXA group than in the placebo group (1 versus 5.5%, p = 0.012). Postoperative hemoglobin levels were higher in the TXA group (12.5 ± 1.2 g/dL versus 11.1 ± 1.5 g/dL, p = 0.002), while transfusion requirements, hemodynamic stability, and length of hospital stay were similar between groups. No postoperative thromboembolic events were observed. Multivariable analysis confirmed TXA as an independent predictor of reduced bleeding and higher postoperative hemoglobin levels.

CONCLUSION

TXA significantly reduced intraoperative bleeding and improved postoperative hemoglobin levels in LSG without increasing hemodynamic instability or the risk of thromboembolic events.