TXA use in radical cystectomy reduces bleeding, need for blood transfusion

Using tranexamic acid (TXA) appears to lessen blood loss and the need for perioperative blood transfusion (PBT) without increasing the risk of venous thromboembolism (VTE) in patients with bladder cancer undergoing radical cystectomy, reports a study.

A total of 2,862 patients with complete data were analysed. Of these, 468 received TXA and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative haemoglobin with a group who did not receive TXA.

TXA recipients had less estimated blood loss intraoperatively (median 600 vs 650 cc) and reduced odds of needing PBT (31 percent vs 50 percent; p<0.001) when compared with TXA nonrecipients. No between-group difference was seen in deep venous thrombosis and pulmonary embolism rate within 90 days of radical cystectomy.

Adjusted survival model analysis revealed no independent association between TXA use and improved overall or cancer-specific survival. On the other hand, PBT correlated with poor overall and cancer-specific survival (p<0.001).

“Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes,” the authors said.

In this study, the authors queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all procedures performed for bladder cancer between 1990 and 2021. They then assessed the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Other outcomes assessed were the impact of TXA use on overall and cancer-specific survival.

“PBT has been reported in >50 percent of patients undergoing radical cystectomy,” the authors said. “Unfortunately, PBT in patients undergoing radical cystectomy has been associated with poor oncological outcomes.”