Tranexamic Acid Did Not Reduce Rate of RBC Transfusion After Bladder Surgery

A recent randomized clinical trial evaluated whether tranexamic acid (TXA) could reduce red blood cell (RBC) transfusions in patients undergoing open radical cystectomy for bladder cancer, a procedure with a high transfusion risk.

While previous studies suggest that TXA effectively reduces blood loss in cardiac and orthopedic surgeries, its use in cancer-related surgeries has been limited due to safety concerns and insufficient evidence. The Tranexamic Acid During Cystectomy Trial (TACT) aimed to address this gap by investigating TXA’s role in reducing transfusions during cystectomy.

In the trial, 344 patients were randomized to receive either TXA or a placebo before surgery. The TXA group was given a loading dose of 10 mg/kg before the incision, followed by a maintenance infusion of 5 mg/kg per hour during surgery. The primary outcome was the rate of RBC transfusions within 30 days post-surgery.

Results showed no significant difference between the two groups: 37% of patients in the TXA group and 37.4% in the placebo group required transfusions. Secondary outcomes, including the number of RBC units transfused, estimated blood loss and the incidence of venous thromboembolism, were also similar between both groups.

The trial’s findings suggest that TXA does not meaningfully reduce transfusion risk during radical cystectomy. The researchers noted that factors such as the use of heparin for venous thromboembolism prophylaxis, the complexity of the surgery and the dosage of TXA may have influenced the lack of effect. These results contrast with findings from TXA trials in cardiac and orthopedic surgeries, where TXA significantly reduced transfusion risk.