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
Keywords:
Prophylactic, Tranexamic Acid, exhibits, Procedure-Specific, Benefits, General Surgery, JAMA, Delgado LM, Pompeu BF, Martins GH
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