Effectiveness of Prophylactic Doses of Tranexamic Acid in Reducing Hemorrhagic Events in Bariatric Surgery: A Systematic Review and Meta-Analysis

Abstract Postoperative bleeding is a major complication in bariatric surgery, contributing to increased morbidity, longer hospital stays, and healthcare costs. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing surgical blood loss in various specialties. However, there is still no consensus regarding its effectiveness and safety in bariatric surgery. We performed a systematic review and meta-analysis to evaluate the impact of prophylactic TXA on hemoglobin levels, procedural duration, and hospital length of stay in bariatric surgery patients. PubMed, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) and observational studies comparing TXA and non-TXA groups in bariatric surgery up to November 2024. Data were independently extracted by two reviewers, and risk of bias was assessed using ROBINS-I and RoB-2. Outcomes were assessed using random-effects models, with heterogeneity evaluated by I2 statistics. Sensitivity analyses and publication bias assessments were also performed. Nine studies (2 RCTs and 7 observational studies) involving 1,956 patients were included. TXA significantly improved hemoglobin levels (MD 0.46 g/dL; 95% CI 0.08–0.84; P = 0.02), reduced procedure duration (MD -9.70 min; 95% CI -14.79 to -4.61; P < 0.01), and shortened hospital length of stay (MD -0.19 days; 95% CI -0.31 to -0.07; P < 0.01). No significant increase in thrombotic events was observed. Sensitivity analyses confirmed the robustness of these findings despite high heterogeneity. Prophylactic TXA may significantly reduce perioperative bleeding (smaller hemoglobin decline), operative time, and length of hospital stay in bariatric surgery, without a signal of increasing thrombotic risks, but this should be interpreted with caution given small sample sizes and low event rates. These results support the integration of TXA into perioperative care protocols for bariatric surgery, offering potential benefits in patient outcomes and surgical efficiency.