Three-dose tranexamic acid protocol feasible in bariatric surgery pilot

A prospective, sequential-period cohort study in Surgical Endoscopy evaluated a standardized tranexamic acid (TXA) protocol in 1,077 adults undergoing sleeve gastrectomy, Roux-en-Y gastric bypass, or revisional surgery. At one academic center, patients were assigned through alternating three-month periods to TXA (549 patients) or no TXA (528). The protocol comprised three 1-g intravenous doses: at anesthesia induction, the evening of surgery, and the following morning. Both groups received standardized thromboprophylaxis. The primary endpoint was implementation feasibility; clinical outcomes were exploratory.

Of 1,122 patients screened, 96.0% were enrolled. Adherence to period-assigned treatment was 94.5%, all patients starting TXA completed the regimen, and 30-day outcome ascertainment was complete. Clinically significant bleeding occurred in 1.46% of patients assigned to TXA periods versus 2.84% during non-TXA periods (p=0.174). Operative time and hospital stay were similar, and no thromboembolic events were observed within 30 days.

The findings support the feasibility of incorporating this regimen into routine bariatric surgical care, rather than establishing efficacy. The single-center, nonrandomized calendar-period design limits causal interpretation, and sample size was based on surgical volume rather than an efficacy calculation. Low bleeding event rates warrant adequately powered studies to determine whether TXA reduces postoperative bleeding. The absence of observed thromboembolic events does not establish safety.