Acta cirurgica brasileira
Tranexamic acid in laparoscopic sleeve gastrectomy: bleeding control amid thrombotic concerns and hemodynamic instability: a randomized double-blinded clinical trial
By Savaş OA, Mercan S, Akbari AM and 1 others.
Abstract
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.