Pilot Evaluation of a Standardized Three-Dose Intravenous Tranexamic Acid Regimen for Bariatric Surgery

By
Paola Llamuca-Castro
Diego Lima
Arturo Estrada
Jason Xia
Yeisson Rivero-Moreno
Raquel Nogueira
Ya Zhou
Tiwalade Adediji
Joseph Vazzana
Diego Camacho
Jenny Choi
Erin Moran-Atkin
October 7, 2026

Surgical Endoscopy

Overview

This prospective, single-center pilot evaluated implementation of a standardized three-dose intravenous tranexamic acid (TXA) regimen in metabolic bariatric surgery. The supplied material describes the study design, cohort, intervention, and perioperative thromboprophylaxis, but does not provide outcome results; feasibility, safety, and clinical effectiveness therefore cannot be summarized from the available text.

Background

Postoperative bleeding is a clinically important complication of metabolic bariatric surgery, with reported rates varying by procedure. Bariatric perioperative care also requires attention to venous thromboembolism (VTE), and the source notes that no accepted protocol has been established to reduce postoperative bleeding across all procedure types. TXA is an antifibrinolytic that stabilizes clots, and its use in bariatric surgery remains under investigation. The study was designed to assess whether a standardized regimen could be implemented before clinical efficacy is evaluated in a larger population.

Data Highlights

Measure	Details reported
Study design and setting	Prospective cohort investigation at one academic institution, September 2023 to August 2024
Screening and cohort	1,122 patients screened; 1,077 included after exclusions
Study-period allocation	TXA intervals: 549 patients; non-TXA intervals: 528 patients, on an intention-to-treat basis
Procedures	Sleeve gastrectomy, Roux-en-Y gastric bypass, or revisional surgery
TXA regimen	Three intravenous 1-g doses: at anesthesia induction, on the evening of surgery, and the following morning
Thromboprophylaxis	Subcutaneous unfractionated heparin initiated at anesthesia induction and administered every 8 hours during hospitalization

Key Findings

The study used alternating three-month calendar intervals: TXA was administered during months 1–3 and 7–9 and withheld during months 4–6 and 10–12.
Of 1,122 patients screened, 1,077 were included; the supplied text reports 549 patients in TXA intervals and 528 in non-TXA intervals on an intention-to-treat basis.
The regimen consisted of three 1-g intravenous TXA doses, given at induction, on the evening of surgery, and the following morning.
All procedures were performed by the same five bariatric surgeons during the study period.
All patients received standardized chemical thromboprophylaxis with subcutaneous unfractionated heparin beginning at induction and every 8 hours during hospitalization.
The supplied study excerpt does not report adherence, follow-up, bleeding outcomes, VTE events, or other clinical results. Related article descriptions identify randomized trials and a meta-analysis of TXA in bariatric surgery, but do not provide enough detail here to establish the results of this pilot.

Clinical Implications

The available material supports describing the protocol and its implementation framework, but not judging its feasibility, safety, or effectiveness because study outcomes are not included. The study paired TXA administration with standardized pharmacologic thromboprophylaxis; the source does not report whether the regimen altered bleeding or VTE outcomes.

Conclusion

This pilot was structured to evaluate a standardized three-dose intravenous TXA protocol across bariatric procedures at a single academic center. Outcome data are needed to determine whether the protocol was implemented reliably and to characterize clinical effects.