Efficacy and Safety of Tranexamic Acid in Abdominoplasty: A Systematic Review and Meta-Analysis.

Background: Abdominoplasty is associated with postoperative bleeding, drainage, and seroma. Methods: We searched four databases from inception through 16 May 2026 for randomized and non-randomized comparative studies of systemic or topical tranexamic acid (TXA). Results: Seven studies (one randomized controlled trial and six observational studies) reported 763 participants across source cohorts; treatment-arm assignment was available for 753. Random-effects meta-analysis associated TXA with lower total drainage volume (MD: -233.32 mL, 95% CI: -351.43 to -115.21), shorter drainage time (MD: -1.36 days, 95% CI: -1.75 to -0.97), shorter hospital stay (MD: -1.48 days, 95% CI: -2.16 to -0.80), smaller absolute hemoglobin drop (MD: -0.87 g/dL, 95% CI: -1.72 to -0.02), and lower seroma odds (OR: 0.51, 95% CI: 0.27 to 0.96). No significant differences were observed for 24 h drainage, relative hemoglobin drop, hematoma, surgical-site infection, wound-healing disorder, or transfusion. Rare adverse events were insufficiently reported. The absolute-hemoglobin and seroma associations were not robust to leave-one-out analysis, and major Doi-plot asymmetry affected several outcomes. Conclusions: TXA may improve selected early outcomes, but the small, mainly observational evidence base supports cautious individualized use rather than a universal regimen.