Tranexamic acid in laparoscopic sleeve gastrectomy: bleeding control amid thrombotic concerns and hemodynamic instability: a randomized double-blinded clinical trial.
Osman Anıl Savaş, Selçuk Mercan, Amir Mahdi Akbari et al.
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In 30 seconds
This randomized, double-blinded clinical trial assessed tranexamic acid (TXA) for perioperative bleeding prevention in 185 patients with morbid obesity undergoing elective laparoscopic sleeve gastrectomy. Patients received TXA or placebo before surgery. Intraoperative bleeding was less frequent with TXA (1 versus 5.5%, p = 0.012), and postoperative hemoglobin was higher (12.5 ± 1.2 g/dL versus 11.1 ± 1.5 g/dL, p = 0.002). Transfusion requirements, hemodynamic stability, and hospital stay were similar between groups; no postoperative thromboembolic events were observed.
Key findings
- Intraoperative bleeding occurred in 1% with TXA versus 5.5% with placebo (p = 0.012).
- Postoperative hemoglobin was 12.5 ± 1.2 g/dL with TXA versus 11.1 ± 1.5 g/dL with placebo (p = 0.002).
- Transfusion requirements, hemodynamic stability, and length of stay were similar between groups.
- No postoperative thromboembolic events were observed.
Why it matters
Bleeding prevention in laparoscopic sleeve gastrectomy must be considered alongside potential thrombotic and hemodynamic concerns. In this trial, TXA was associated with less intraoperative bleeding and higher postoperative hemoglobin, without observed differences in hemodynamic stability or transfusion requirements. The findings inform assessment of TXA in this surgical setting, while the absence of observed thromboembolic events does not establish that risk is absent.
What to keep in mind
The trial included 185 patients, and no postoperative thromboembolic events were observed; the abstract does not establish the ability to detect uncommon thrombotic harms.