BackgroundThe efficacy of tranexamic acid in elective major invasive abdominal surgeries has not yet been established. We investigated the effect of tranexamic acid administration on intraoperative blood loss during peritoneal resection of pseudomucinoma and cancerous peritoneal dissemination.MethodsPatients aged ≥ 20 years old who underwent peritoneal resection for pseudomucinoma or cancerous peritoneal dissemination at the Kishiwada Tokushukai Hospital were included in this single-center retrospective observational study. The tranexamic acid group received 1000 mg of tranexamic acid at the start of the operation, while the control group received the same intraoperative management as the tranexamic acid group, except for the tranexamic acid administration. The primary endpoint was intraoperative blood loss, and a multivariate analysis of the contributing factors was performed.ResultsThe median volume of intraoperative blood loss was 1372 [interquartile range, 842 − 1877] mL and 907 [516 − 1537] mL in the control and tranexamic acid groups, respectively (p< 0.01). The total volume of blood transfusion during the operation was 2040 [1480 − 2380] mL and 1560 [1000 − 2120] mL in the control and tranexamic acid groups, respectively (p= 0.02). Postoperative blood test results revealed D-dimer values of 7.5 [4.1 − 10.7] µg/mL and 1.8 [1.0 − 3.3] µg/mL in the control and tranexamic acid groups, respectively (p< 0.01). Multivariate analysis showed that tranexamic acid administration was significantly associated with decreased intraoperative blood loss (p= 0.02).ConclusionTranexamic acid administration may be useful in reducing intraoperative blood loss and blood transfusion volume during highly-invasive surgeries such as peritoneal resection of pseudomucinoma and cancerous peritoneal dissemination.