Efficacy and safety of tranexamic acid in non-gynecological abdominal and pelvic oncological surgery: a systematic review and meta-analysis.

Abdominal and pelvic oncological surgeries are challenged with intraoperative blood loss, which leads to transfusion requirements and is linked to severe postoperative complications and poorer outcomes. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been widely used to reduce bleeding and transfusion requirements in various surgical procedures. This systematic review focuses exclusively on the efficacy and safety of TXA administration in non-gynecological abdominal and pelvic oncologic surgeries.

Methods

PubMed, Embase, and Web of Science databases were searched from inception to May 2025. Eligible studies evaluated the effect of TXA on bleeding outcomes in patients undergoing non-gynecological abdominal and pelvic oncologic surgery.

Results

Nine randomized controlled trials with a total of 2472 patients met the inclusion criteria. Data were synthesized using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). TXA did not appear to significantly affect perioperative transfusion rate (RR =0.91, 95% CI: 0.66 to 1.26). Pooled analysis suggested that TXA was associated with a significant reduction in intraoperative blood loss (MD = -105.76, 95% CI: -200.51 to -11.01). For other outcomes-transfusion units (MD = -0.20, 95% CI: -0.72 to 0.33) or change in serum haemoglobin (MD = -1.13, 95% CI: -2.60 to 0.34), -no significant differences were detected. Mortality and risk of venous thromboembolism (VTE) did not differ significantly (RR = 2.30, 95% CI: 0.65 to 8.13) and (RR = 1.59, 95% CI: 0.93 to 2.72).

Conclusion

Among patients undergoing non-gynecological abdominal and pelvic oncologic surgeries, TXA was not associated with a statistically significant reduction in perioperative transfusion rates or other clinically relevant outcomes, although a potential reduction in intraoperative blood loss was observed. Meanwhile, no statistically significant difference was observed in the risk of VTE and mortality.