The Effect of Preoperative Single-Dose Tranexamic Acid on Bleeding and Thromboembolic Events Following Bariatric Surgery

Background: Intravenous tranexamic acid (TXA) has been shown to reduce perioperative blood loss and transfusion needs in various surgeries. However, its effectiveness in minimizing these complications during metabolic bariatric surgery remains unclear. This study aimed to determine whether a single prophylactic dose of intravenous TXA administered before metabolic bariatric surgery reduces the risk of perioperative hemorrhage. Methods: A retrospective analysis was conducted on patients who underwent metabolic bariatric surgery at our institute from 2019 to 2022, with routine TXA administration starting in 2021. A comparison was made between the TXA and non-TXA groups, with all surgeries performed by a single surgical team. Results: A total of 901 patients were included, with 560 (62.2%) in the non-TXA group and 341 (37.8%) in the TXA group. There were no significant differences between groups in age, sex, or preoperative BMI, although a higher proportion of post-2021 patients underwent gastric bypass. No significant differences were observed in the percentage of patients with bloody surgical drains (4.2% vs. 4.9%, p = 0.662), transfusion need (1.5% vs. 1.6%, p = 1), re-operations for bleeding (3.2% vs. 2.3%, p = 0.582), or postoperative thromboembolic events (0.2% vs. 0%, p = 1.0). Conclusions: A single dose of intravenous TXA did not reduce postoperative bleeding in bariatric patients, nor were there significant differences in thromboembolic events or mortality between groups. Further randomized controlled trials are needed to confirm or refute TXA’s effectiveness in reducing this potentially life-threatening complication.