Effectiveness of prophylactic doses of tranexamic acid in reducing hemorrhagic events in sleeve gastrectomy

Abstract

Purpose Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric surgery in the world. Although it appears to be a safe treatment for obesity, it is still at risk of complications. The latest literature shows that postoperative bleeding occurs in 2–4% of cases, and up to 3% of cases requires reoperation for hemostasis. The aim of the study is to assess the effect of tranexamic acid (TXA) on hemorrhagic events and the reoperation rate in patients undergoing LSG. Methods The study was designed as a retrospective analysis of patients undergoing LSG. We investigate the patients 6 months before and 6 months after introducing the prophylaxis doses of TXA into our bariatric protocol (non-TXA group vs TXA group). Results Three hundred fourteen patients underwent LSG in a high-volume center from 2016 to 2017. After introducing TXA, a statistically significant reduction in the incidence of hemorrhage during surgery was observed (22.3% vs 10.8%, p = 0.006). There was a statistically significant reduction in the need for the staple line oversewing (10.2% vs 1.9%, p = 0.002). The mean operating time and the mean length of hospital stay were significantly higher in the non-TXA group than TXA group (63.1 vs 53.7 min, p < 000.1; 2.3 vs 2.1, p = 0.02). In both groups of patients, no venous thromboembolism or other complications occurred within 6 months after the surgery. Conclusions The prophylactic doses of TXA may be useful in reducing the hemorrhagic events during LSG. It may also shorten the length of hospital stay and the operating time.

The Role of Tranexamic Acid in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

“…The design of the included studies was either RCT, cohort, or non-randomized trial. Appraisal of the cohort studies yielded an overall fair quality [ 18 , 28 ]. Brito and the associated team [ 29 ] conducted a non-randomized trial of overall good quality; the only domain with not-reported data was the inclusion of consecutive patients' domain (Tables 2 , 3 ).…”

“…Operative time (minutes): Five studies with substantial heterogeneity provided data from 644 patients [ 18 , 21 , 22 , 28 , 29 ] that revealed significantly shorter operative time in the TXA group compared to the control group (MD= -5.84, 95%CI [-9.62, -2.05], P=0.003, I2=73%) (Figure 5 ).…”

“…Length of hospital stay (days): Analysis of three homogenous studies enrolling 476 patients [ 22 , 28 , 29 ] showed a significantly shorter hospital stay associated with the TXA group compared to the control group (MD=-0.24, 95%CI [-0.32, -0.17], P< 0.00001, I2 =0%) (Figure 8 ).…”

A patient blood management perspective on Anemia in the obese patient journey

“…Although the causality and pathophysiological mechanism are unclear, TXA use is associated with improvement in clinical outcomes in acute trauma, postpartum hemorrhage and orthopedic surgery (29)(30)(31). In metabolic surgery, around 2%-4% of patients experience bleeding, with 3% requiring reoperation (32). Tranexamic acid has been reported to reduce the incidence of bleeding, surgery duration, hospital length of stay, without increasing thromboembolic events (32)(33)(34).…”

“…In metabolic surgery, around 2%-4% of patients experience bleeding, with 3% requiring reoperation (32). Tranexamic acid has been reported to reduce the incidence of bleeding, surgery duration, hospital length of stay, without increasing thromboembolic events (32)(33)(34). A metaanalysis suggested that a dose of 1 g of TXA given at anesthetic induction might be as effective as higher doses (35).…”