Prophylactic Tranexamic Acid exhibits Procedure-Specific Benefits in General Surgery: JAMA

Medically Reviewed By : Dr. Kamal Kant Kohli

Published On 2025-12-21 15:00 GMT | Update On 2025-12-22 07:00 GMT

Prophylactic tranexamic acid appears to be safe and is associated with reduced bleeding in general surgery. However, its effectiveness varies depending on the type of surgical procedure, and therefore its use should not be uniformly generalized across all surgical settings.

Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. A study was done to evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the I2 statistic.

Results Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, −35.85 mL; 95% CI, −57.20 to −14.51 mL; I2 = 91%; P = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; I2 = 54%; P = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; I2 = 0%; P = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; I2 = 15%; P = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; I2 = 0%; P = .71), and length of stay (MD, −0.54 days; 95% CI, −1.15 to 0.06 days; I2 = 73%; P = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; I2 = 0%; P = .01), while no significant differences were observed for the other outcomes.

This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in thromboembolic or mortality risk. Although these findings support the use of TXA in general surgery procedures, the decision to use TXA should be individualized considering individual patient characteristics and the specific procedure being performed.

Reference:

Delgado LM, Pompeu BF, Martins GHA, et al. Perioperative Use of Tranexamic Acid in General Surgery: A Systematic Review and Meta-Analysis. JAMA Surg. Published online December 17, 2025. doi:10.1001/jamasurg.2025.5498

Article Source : JAMA

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Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

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Prophylactic Tranexamic Acid exhibits Procedure-Specific Benefits in General Surgery: JAMA

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