Tranexamic acid use during open radical cystectomy for bladder cancer of no benefit

Treatment with tranexamic acid does not appear to reduce blood transfusion in patients during open radical cystectomy for bladder cancer, as shown in the results of the Tranexamic Acid During Cystectomy Trial (TACT).

A total of 353 patients (median age 69 years, 74.5 percent male) who were scheduled for open radical cystectomy for the treatment of bladder cancer participated in TACT. The patients who were randomly allocated to the intervention group received a loading dose of intravenous tranexamic acid at 10 mg/kg prior to incision, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. Those who were allocated to the control group, on the other hand, received matching placebo.

Of the patients, 344 were included in the intention-to-treat analysis. The proportion of patients who received red blood cell (RBC) transfusion up to 30 days after surgery—the primary study outcome—did not significantly differ between the intervention and the control group (37.0 percent vs 37.4 percent; relative risk, 0.99, 95 percent confidence interval, 0.83–1.18).

Likewise, the two treatment groups were comparable in terms of secondary outcomes such as the mean number of RBC units transfused (0.9 vs 1.1 U; p=0.43), estimated blood loss (927 vs 963 mL; p=0.52), intraoperative transfusion (28.3 percent vs 24.0 percent; p=0.08), or venous thromboembolic events (3.5 percent vs 2.9 percent; p=0.57).

As for safety, nontransfusion-related adverse events were similar between the intervention and control groups.

The findings do not support routine use of tranexamic acid during open radical cystectomy.