TXA significantly reduces intraoperative bleeding, hemoglobin decline, and staple-line interventions without increasing complications in sleeve gastrectomy.
Meta-analyses confirm TXA halves postoperative bleeding odds and shortens operative duration and hospitalization without increasing venous thromboembolism (VTE) or mortality.
No increase in thromboembolic events reported despite baseline elevated VTE risk in obese patients; however, optimal dosing and timing require further multicenter studies.
Guideline-Based Recommendations
Diagnosis
Identify candidates for sleeve gastrectomy based on BMI and obesity-related comorbidities per 2022 ASMBS/IFSO criteria.
Exclude patients with known coagulopathy, prior VTE, recent anticoagulant use, or significant organ impairment.
Management
Administer a single preoperative intravenous dose of 1 g tranexamic acid diluted in 100 mL saline over 10–15 minutes immediately after anesthesia induction and before skin incision.
Maintain blinding and standardized anesthesia and surgical protocols to ensure consistent care.
Monitoring & Follow-up
Monitor intraoperative bleeding, hemoglobin levels, and staple-line interventions.
Observe for thromboembolic events postoperatively despite low reported incidence.
Assess for transfusion requirements and length of hospital stay.
Risks
Theoretical risk of increased VTE in obese patients; however, current evidence shows no increase in thrombotic complications with TXA use in sleeve gastrectomy.
Contraindications include allergy to TXA, active coagulopathy, recent thrombotic events, and severe renal or hepatic impairment.
Patient & Prescribing Data
Adults aged 18–60 years undergoing primary sleeve gastrectomy with BMI criteria and no contraindications to TXA.
Single preoperative intravenous dose of 1 g TXA reduces bleeding and operative time without increasing thromboembolic risk; transfusion reduction trend noted but not statistically significant.
Clinical Best Practices
Use standardized dosing and timing of TXA administration immediately after anesthesia induction and before incision.
Ensure exclusion of patients with high thrombotic risk or contraindications prior to TXA use.
Maintain multidisciplinary blinding to minimize bias in randomized controlled trials.
Standardize anesthesia and surgical techniques to reduce variability in bleeding outcomes.
Continue surveillance for thromboembolic events despite reassuring safety data.
