Safety and efficacy of tranexamic acid in radical cystectomy: a systematic review and meta-analysis.

Abstract

Introduction: Perioperative blood transfusion (BT) is often required in radical cystectomy (RC) due to significant blood loss. Tranexamic acid (TXA), an antifibrinolytic agent, reduces bleeding, but concerns about thromboembolic risks persist. This systematic review and meta-analysis evaluate TXA's efficacy and safety in RC.

Material and methods: A systematic search was conducted in PubMed, Embase, and Cochrane Central databases. Randomized controlled trials (RCTs) and retrospective studies comparing TXA versus controls in RC were included. Primary outcomes were perioperative, intraoperative, and postoperative BT rates. Secondary outcomes included estimated blood loss (EBL) and thromboembolic events (PROSPERO; CRD420251013502).

Results: Four studies totaling 1,656 patients were included. TXA significantly reduced perioperative transfusion rates (OR = 0.40; 95% CI: 0.30-0.51; p < 0.00001). However, intraoperative (OR = 0.87; 95% CI: 0.50-1.52; p = 0.63) and postoperative transfusion rates (OR = 0.51; 95% CI: 0.21-1.23; p = 0.13) were not significantly different. No significant difference was found in EBL (MD = -9.31; 95% CI: from -82.50 to 63.87; p = 0.80). Safety analysis showed no increased risk of deep vein thrombosis (OR = 1.14; 95% CI: 0.54-2.41; p = 0.72) or pulmonary embolism (OR = 1.49; 95% CI: 0.69-3.24; p = 0.31).

Conclusions: TXA reduces perioperative transfusion needs in RC without significantly affecting intraoperative or postoperative transfusion rates, EBL, or thromboembolic risk. Further RCTs are needed to optimize TXA use in RC.