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Efficacy and Safety of Tranexamic Acid in Solid Cancer Surgeries: A Systematic Review and Meta-analysis of Randomized
Asmaa Soliman1,2, Ahmed Adel Abdel Azim3,4, Abdullrahman Elgarawany5,4
1Faculty of Medicine, Zagazig University, Sharqia, Egypt. asmaamohamed8967@gmail.com.
Background:
There is a significant risk of blood loss and transfusion requirements during surgeries for different cancers, raising perioperative morbidity and mortality. The antifibrinolytic drug tranexamic acid (TXA) has been studied to address this issue, but the results remain conflicting. This systematic review and meta-analysis pools all available evidence regarding the use of this medication in cancer surgeries.
Patients And Methods:
The PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases were used for data retrieval until 29 April 2025. Any randomized controlled trial involving surgical patients with cancer who received TXA as the intervention was included. The main addressed outcomes were perioperative blood loss, transfusion requirements, and complications. Study quality and evidence certainty were appraised with the Cochrane RoB 2.0 tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
Results:
A total of 16 RCTs with 1830 patients were analyzed. TXA markedly reduced total, intraoperative, and postoperative blood loss compared with control. Hemoglobin changes were also smaller in the TXA group. Intraoperative blood component and perioperative red blood cell transfusions were lower with TXA. TXA was also linked to a modest reduction in operative time. No significant differences were observed between the groups for perioperative complications, reoperation rate, in-hospital or 30-day mortality, and length of hospital stay. GRADE assessments for the outcomes were mainly moderate or low, except for two that had very low certainty.
Conclusions:
TXA appears to statistically improve perioperative outcomes in cancer surgeries while maintaining a favorable safety profile.
