Efficacy and Safety of Tranexamic Acid Use in Bariatric Surgery: An Updated Systematic Review and Meta-Analysis

Intravenous tranexamic acid (TXA) is increasingly used to reduce perioperative bleeding. Its safety in bariatric surgery, a population with chronic inflammation and hypercoagulability, remains unclear. Following PRISMA guidelines, 11 comparative studies (five RCTs, four retrospective cohorts, two prospective cohorts; n = 1,959) were analyzed. TXA significantly reduced transfusion risk (RR 0.29, 95%CI 0.11–0.80), bleeding events (RR 0.46, 95%CI 0.32–0.67), postoperative hemoglobin reduction (MD 0.24 g/dL, 95%CI 0.04–0.44), length of stay, and operative time. Intraoperative blood loss was unchanged. RCT-only analyses showed consistent reductions in bleeding and hemoglobin drop. No deep venous thromboembolism events were reported. Overall, TXA may reduce bleeding-related outcomes in bariatric surgery without an observed thromboembolic signal, though low event rates limit certainty, and further randomized trials are needed. Word count: 120/125.