Tranexamic Acid During Radical Cystectomy: A Randomized Clinical Trial

Area of Science:

• Urology
• Surgical Oncology
• Anesthesiology

Background:

• Open radical cystectomy for bladder cancer carries a high risk of red blood cell (RBC) transfusion.
• Prophylactic tranexamic acid (TXA) is known to reduce blood loss in other surgical settings.
• The potential benefit of TXA in radical cystectomy warranted investigation.

Purpose of the Study:

• To evaluate the efficacy of prophylactic tranexamic acid (TXA) in reducing RBC transfusions up to 30 days after open radical cystectomy.
• To assess the impact of TXA on blood loss and other perioperative outcomes in patients undergoing radical cystectomy.

Main Methods:

• The Tranexamic Acid During Cystectomy Trial (TACT) was a multicenter, double-blind, placebo-controlled, randomized clinical trial.
• 353 patients undergoing planned open radical cystectomy were randomized to receive either intravenous TXA or a matching placebo.
• The primary outcome was the receipt of RBC transfusion within 30 days post-surgery.

Main Results:

• RBC transfusion occurred in 37.0% of patients receiving TXA versus 37.4% receiving placebo (relative risk, 0.99; 95% CI, 0.83-1.18).
• No significant differences were observed in secondary outcomes, including mean RBC units transfused, estimated blood loss, intraoperative transfusion rates, or venous thromboembolic events.
• Adverse events were similar between the TXA and placebo groups.

Conclusions:

• Prophylactic tranexamic acid (TXA) administration did not significantly reduce red blood cell transfusions in patients undergoing open radical cystectomy for bladder cancer.
• Based on the TACT trial results, routine use of TXA in this surgical context is not recommended.
• Further research may explore alternative strategies for blood loss management in radical cystectomy.