Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Department of Medicine, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Obes Surg. 2023 May;33(5):1571-1579. doi: 10.1007/s11695-023-06563-w. Epub 2023 Mar 28.
Tranexamic acid (TXA) has drawn growing interest over the last decade for its benefit in optimizing post-operative bleeding, yet its role in bariatric surgery is poorly understood.
The medical librarian developed and executed comprehensive searches on September 28, 2022. The population of interest included adults who underwent elective bariatric surgery. The intervention was tranexamic acid administration while the comparison was placebo or standard peri-operative therapy. The primary outcome of interest was post-operative bleeding which was defined a priori.
A total of four studies were identified comprising of 475 patients. Of those, 207 (50%) received TXA at induction and all underwent laparoscopic sleeve gastrectomy (LSG). The majority of patients were female (n = 343, 80.7%) with ages ranging from 17 to 70 years of age and mean BMIs ranging from 37 to 56 kg/m. Post-operative bleeding after LSG ranged from 0 to 28% depending on bleed definition and TXA administration with no differences in venous thromboembolic events or mortality between groups. Meta-analysis of post-operative bleeding demonstrated a statistically significant benefit with TXA administration (OR 0.40; 95% CI 0.23-0.70; p = 0.001) for patients undergoing elective LSG.
Intravenous tranexamic acid at the time of laparoscopic sleeve gastrectomy is associated with a significant reduction of post-operative bleeding with no observed differences in thromboembolic events or mortality. Further high-quality studies are needed to better delineate the ideal bariatric population to receives TXA in addition to the optimal timing, dose, and duration of TXA therapy.
在过去的十年中，氨甲环酸（TXA）因其优化术后出血的益处而引起了越来越多的关注，但它在减重手术中的作用仍知之甚少。
医学图书管理员于 2022 年 9 月 28 日进行并执行了全面的检索。研究对象为接受择期减重手术的成年人。干预措施为氨甲环酸给药，比较组为安慰剂或标准围手术期治疗。主要观察指标为术后出血，该指标为事先定义。
共确定了四项研究，共纳入 475 例患者。其中，207 例（50%）在诱导时接受了 TXA，所有患者均接受了腹腔镜袖状胃切除术（LSG）。大多数患者为女性（n=343，80.7%），年龄在 17 至 70 岁之间，平均 BMI 在 37 至 56 kg/m 之间。根据出血定义和 TXA 给药情况，LSG 术后出血率在 0 至 28%之间不等，各组间静脉血栓栓塞事件或死亡率无差异。术后出血的荟萃分析显示，接受择期 LSG 的患者给予 TXA 治疗具有统计学显著获益（OR 0.40；95%CI 0.23-0.70；p=0.001）。
在腹腔镜袖状胃切除术时给予静脉注射氨甲环酸可显著减少术后出血，而血栓栓塞事件或死亡率无差异。需要进一步开展高质量的研究，以更好地确定接受 TXA 的理想减重人群，以及 TXA 治疗的最佳时机、剂量和持续时间。
