Evaluating the Safety of Tranexamic Acid in Cancer Surgery: Clinical Evidence and Biological Rationale

Area of Science:

• Oncology
• Hematology
• Surgical Sciences

Background:

• Tranexamic acid (TXA) is a common antifibrinolytic agent used to minimize blood loss in surgery.
• Its application in oncologic surgery is debated due to theoretical risks of venous thromboembolism (VTE) and tumor progression.

Purpose of the Study:

• To conduct an analytic review of existing clinical and laboratory evidence on TXA use in cancer surgery.
• To evaluate the safety and efficacy of TXA concerning blood transfusion, VTE, and oncologic outcomes.

Main Methods:

• A clinically focused review of experimental and clinical evidence was performed.
• A structured literature search of major databases (MEDLINE, Embase, CENTRAL, Web of Science) was conducted through May 2025.
• Findings were synthesized narratively, prioritizing key studies and emphasizing clinical outcomes and biological plausibility.

Main Results:

• Retrospective studies suggest TXA reduces red cell transfusions in cancer patients.
• Recent oncology trials show decreased blood loss but no reduction in transfusion needs.
• Postoperative VTE rates were low (0-3%) and similar between TXA and control groups.
• Limited, underpowered studies show no evidence of oncologic harm, though laboratory findings are equivocal.

Conclusions:

• The impact of TXA on transfusion requirements in oncologic surgery is ambiguous.
• Current data do not suggest an increased VTE risk or oncologic harm, but evidence is limited.
• Further cancer-specific studies with long-term follow-up are necessary to definitively establish oncologic safety and outcomes.