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Published on: January 22, 2022
Tranexamic acid in radical cystectomy: a systematic review and meta-analysis
Fatemeh Fereidooni1, Masoud Dehbozorgi2, Davoud Khalilzadeh Bonab3
1School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Background:
Radical cystectomy is associated with substantial blood loss and transfusion requirements, raising the potential role of tranexamic acid (TXA) to mitigate these risks. However, its effectiveness and safety in this context remain to be fully established.
Methods:
A comprehensive search of PubMed, Embase, Web of Science, and Scopus from inception to May 19, 2025, identified studies involving adult patients undergoing cystectomy (partial or radical) comparing TXA with placebo, no treatment, or alternative hemostatic agents.
Results:
Four studies (1 RCT, 3 cohort studies) with sample sizes ranging from 64 to 936 patients were included. TXA significantly reduced estimated blood loss (SMD = -0.11; 95% CI: -0.21, -0.01; p = 0.03) and total transfusion volume (SMD = -0.28; 95% CI: -0.54, -0.02; p = 0.04). The odds of receiving any transfusion decreased by 52% (OR = 0.48; 95% CI: 0.30, 0.77; p = 0.002), with postoperative transfusion reduction particularly notable (OR = 0.32; 95% CI: 0.16, 0.63; p < 0.001). TXA showed no significant effect on intraoperative transfusion needs (OR = 0.95; p = 0.79) or perioperative hemoglobin change (SMD = 0.17; p = 0.08). Importantly, TXA did not increase VTE risk (OR = 1.49; p = 0.16) and was associated with a lower postoperative mortality in pooled analyses (OR = 0.62; 95% CI: 0.47, 0.82; p = 0.001).
Conclusions:
Tranexamic acid appears effective in reducing blood loss and transfusion requirements during cystectomy, with no evidence of increased VTE risk and a potential survival benefit.
