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Tranexamic acid results in better LSG outcomes compared to placebo

Tranexamic acid (TXA) demonstrates a robust safety and efficacy profile for its use in patients undergoing laparoscopic sleeve gastrectomy (LSG) with a significant reduction in hospitalisation time and bleeding incidents during and post-LSG compared to the control group, according to a systematic review and meta-analysis led by researchers from King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia.

Their meta-analysis evaluated and investigated the current intra- and postoperative effects and hazards of TXA on patients undergoing LSG, and identified six studies (753 patients) conducted in Kuwait, Brazil, United Kingdom, Poland, the Netherlands and Turkey (randomised controlled trial, cohort or non-randomised trial). The mean BMI spanned between 37.3 and 56.25 kg/m2, their reported mean age ranged from 33.5 to 43.25 years, and females represented around 80% of the whole enrolled population.


Outcomes

The results revealed that intraoperative bleeding events (581 patients) were significantly reduced in the group administered TXA compared to the control group (p=0.04). Moreover, intraoperative blood loss (ml) was lover in the group administered TXA compared to the control group (229 patients, p=0.03).


In addition, operative time (minutes) were significantly shorter in the TXA group compared to the control group (644 patients, p=0.003). The researchers reported no significant difference between the TXA and the control groups regarding the number of clips of haemostasis according to pooling 280 patients' data from three studies (p=0.99).


An analysis of six studies (693 patients) showed the TXA group was significantly associated with a 55% reduction in risk of postoperative bleeding events compared to the control group (p=0.0002), and patients in the TXA group had a lower length of hospital stay (days) compared to the control group (476 patients, p<0.00001).


There was no significant difference between the TXA and the control groups regarding pre-postoperative haemoglobin change (g per dl), according to the pooled 594 patients' data from four mildly heterogeneous studies (p=0.09).


“To our knowledge, no studies have demonstrated an increase in postoperative VTE rates following the implementation of TXA. Given these findings, considering our follow-up period and the absence of reported thromboembolic events, we argue that our study presents a compelling case for using TXA in LSG, with a negligible risk of thromboembolic events,” the authors concluded. “Variations in TXA administration regimens, bleeding definitions, procedural techniques, and potential confounders, including antiplatelet and anticoagulants, could not be accounted for, necessitating additional large-scale RCTs to address and bridge those knowledge gaps.”


The findings were reported in the paper, ‘The Role of Tranexamic Acid in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis’, published in Cureus. To access this paper, please click here

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