Efficacy and Safety of Intraoperative Tranexamic Acid Infusion for Reducing Blood Transfusion During Open Radical Cystectomy

Abstract

To evaluate the safety and efficacy of intraoperative tranexamic acid (TA), an antifibrinolytic, in reducing perioperative blood transfusion (PBT) for patients undergoing open radical cystectomy (RC) for bladder cancer. We instituted a change in our institutional clinical practice starting in April 2013, whereby all patients undergoing open RC were administered intraoperative intravenous TA. Patients with a history of venous thromboembolism (VTE) or coronary stent insertion within the year prior to RC did not receive TA. Receipt of a PBT, defined as transfusion of red blood cells during RC or within the postoperative hospitalization, and VTE within 30 days of RC were recorded and compared with a matched cohort of patients treated with RC at our center prior to the initiation of TA utilization. A total of 103 patients received TA during open RC between April 2013 and July 2015. These patients were matched 1:2 to historic controls. We found that TA infusion was associated with a significantly decreased rate of PBT, as 32 of 103 (31.1%) patients treated with TA received a PBT, versus 115 of 200 (57.7%) matched controls (P < .0001). Importantly, TA did not significantly increase the rate of perioperative VTE, as 5 patients (4.9%) who received TA were diagnosed with a VTE within 30 days of RC, compared with 6 (3.0%) of the matched controls (P = .52). We noted that the use of intraoperative TA during open RC was associated with a significant reduction in PBT, and did not significantly increase perioperative VTE risk.