Perioperative blood transfusion has been reported in > 50% of patients undergoing Radical cystectomy (RC). Unfortunately, perioperative blood transfusion in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for perioperative blood transfusion. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and VTE in patients undergoing radical cystectomy (RC). We also investigate its long-term impact on overall survival (OS) and cancer-specific survival outcomes (CSS).
We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RC performed for bladder cancer between 1990-2021. Primary outcomes assessed include the risk of peri-operative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS.
Out 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-non-recipient). TXA-recipients experienced less estimated blood loss (EBL) intraoperatively (median of 600 versus 650) cc and were less likely to need PBT (31% versus 50%, p-value <0.001) compared to TXA-non recipients. There was no difference between groups in deep venous thrombosis (DVT) and pulmonary embolism (PE) rates within 90 days of RC. In adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, peri-operative blood transfusion was associated with poor OS and CSS (p-value <0.001).
TXA use was associated with a significant reduction in EBL and perioperative blood transfusion without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved overall survival as well as cancer-specific survival. However, in multivariable analyses, TXA itself was not independently associated with improved overall survival (OS) or cancer-specific survival (CSS); instead, perioperative blood transfusion was. Further studies are warranted to explore strategies for minimizing perioperative blood transfusions and their impact on survival outcomes.
The Journal of urology. 2024 Dec 02 [Epub ahead of print]
Mohamed E Ahmed, Jack R Andrews, Ahmed M Mahmoud, Giuseppe Reitano, Prabin Thapa, Mark D Tyson, Abhinav Khanna, Paras Shah, Vidit Sharma, R Houston Thompson, Stephen A Boorjian, Igor Frank, Matthew K Tollefson, R Jeffrey Karnes
Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Mayo Clinic, Arizona, Phoenix, AZ, USA.