TY - JOUR
T1 - Intraoperative Tranexamic Acid in Radical Cystectomy
T2 - Impact on Bleeding, Thromboembolism, and Survival Outcomes
AU - Ahmed, Mohamed E.
AU - Andrews, Jack R.
AU - Mahmoud, Ahmed M.
AU - Reitano, Giuseppe
AU - Thapa, Prabin
AU - Tyson, Mark D.
AU - Khanna, Abhinav
AU - Shah, Paras
AU - Sharma, Vidit
AU - Thompson, R. Houston
AU - Boorjian, Stephen A.
AU - Frank, Igor
AU - Tollefson, Matthew K.
AU - Karnes, R. Jeffrey
N1 - Publisher Copyright:
© 2025 Wolters Kluwer Health. All rights reserved.
PY - 2025/4/1
Y1 - 2025/4/1
N2 - Purpose:Perioperative blood transfusion (PBT) has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, PBT in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and venous thromboembolism (VTE) in patients undergoing RC. We also investigate its long-term impact on overall survival (OS) and cancer-specific survival (CSS) outcomes.Materials and Methods:We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RCs performed for bladder cancer between 1990 and 2021. Primary outcomes assessed include the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS.Results:Of 2862 patients with complete available data, 468 received TXA (TXA recipient) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (TXA nonrecipient). TXA recipients experienced less estimated blood loss intraoperatively (median 600 vs 650 cc) and were less likely to need PBT (31% vs 50%, P <.001) compared with TXA nonrecipients. There was no difference between groups in deep venous thrombosis and pulmonary embolism rates within 90 days of RC. In the adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, perioperative blood transfusion was associated with poor OS and CSS (P <.001).Conclusions:TXA use was associated with a significant reduction in estimated blood loss and PBT without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved OS as well as CSS. However, in multivariable analyses, TXA itself was not independently associated with improved OS or CSS; instead, PBT was. Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes.
AB - Purpose:Perioperative blood transfusion (PBT) has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, PBT in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and venous thromboembolism (VTE) in patients undergoing RC. We also investigate its long-term impact on overall survival (OS) and cancer-specific survival (CSS) outcomes.Materials and Methods:We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RCs performed for bladder cancer between 1990 and 2021. Primary outcomes assessed include the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS.Results:Of 2862 patients with complete available data, 468 received TXA (TXA recipient) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (TXA nonrecipient). TXA recipients experienced less estimated blood loss intraoperatively (median 600 vs 650 cc) and were less likely to need PBT (31% vs 50%, P <.001) compared with TXA nonrecipients. There was no difference between groups in deep venous thrombosis and pulmonary embolism rates within 90 days of RC. In the adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, perioperative blood transfusion was associated with poor OS and CSS (P <.001).Conclusions:TXA use was associated with a significant reduction in estimated blood loss and PBT without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved OS as well as CSS. However, in multivariable analyses, TXA itself was not independently associated with improved OS or CSS; instead, PBT was. Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes.
KW - bladder cancer
KW - perioperative bleeding
KW - radical cystectomy
KW - tranexamic acid
KW - venous thromboembolism
UR - https://www.scopus.com/pages/publications/85213870661
UR - https://www.scopus.com/inward/citedby.url?scp=85213870661&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000004358
DO - 10.1097/JU.0000000000004358
M3 - Article
C2 - 39621967
AN - SCOPUS:85213870661
SN - 0022-5347
VL - 213
SP - 447
EP - 454
JO - Journal of Urology
JF - Journal of Urology
IS - 4
ER -