Tranexamic acid in sleeve gastrectomy reduced bleeding but not transfusion

Design

Randomised, double-blinded, placebo-controlled trial

Population

185 adults with severe obesity having elective laparoscopic sleeve gastrectomy

Primary outcome

Perioperative bleeding and 24-hour haemoglobin

Effect

Intraoperative bleeding 1% vs 5.5% (p = 0.012); haemoglobin 12.5 vs 11.1 g/dL

In this double-blinded trial, 185 patients with severe obesity having elective laparoscopic sleeve gastrectomy received tranexamic acid (93) or placebo (92) before surgery. Outcomes included bleeding needing transfusion, haemoglobin at 24 hours, haemodynamics and thrombotic events.

Intraoperative bleeding was less frequent with tranexamic acid (1% vs 5.5%, p = 0.012), and haemoglobin at 24 hours was higher (12.5 vs 11.1 g/dL, p = 0.002). Transfusion needs, haemodynamic stability and length of stay did not differ, and no thromboembolic events occurred in either group.

Bariatric patients carry a high baseline thrombotic risk, which has made some teams cautious with tranexamic acid. This trial found no signal of harm, but 185 patients cannot rule out a rare thrombotic event, and the absence of a transfusion benefit means the gain is modest. It is a reasonable option where staple-line bleeding is a concern, alongside standard thromboprophylaxis.

• Consider a single prophylactic dose of tranexamic acid for sleeve gastrectomy where bleeding risk is a concern.
• Continue standard mechanical and pharmacological thromboprophylaxis whether or not tranexamic acid is given.
• Do not expect fewer transfusions; the trial showed less bleeding, not less transfusion.
• Check for contraindications such as previous venous thromboembolism before giving it.

Why it matters

A thrombotic concern has kept tranexamic acid out of many bariatric lists, and this trial found no sign of it.

Don't overread it

The trial was too small to exclude a rare thrombotic harm, and transfusion was not reduced.

The statistics, in plain English

Bleeding fell from 5.5% to 1%, an absolute difference of about 4.5 percentage points, or roughly one bleed avoided for every 22 patients treated. Zero thrombotic events in 93 treated patients is reassuring but too few to exclude an uncommon risk.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.