Multicenter randomized trial of tranexamic acid during open radical cystectomy for bladder cancer

Among cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loos during cardiac and orthopedic surgery. A randomized trial at ten academic centers in Canada evaluated intraoperative prophylactic TXA in patients undergoing open radical cystectomy for bladder cancer. In this trial that included 353 adult patients, 37.0% of patients treated with TXA received a RBC transfusion in the first 30 days after surgery, compared with 37.4% of patients treated with placebo (RR 0.99; 95% CI 0.83-1.18). There were also no significant differences between the two groups in secondary outcomes, including mean number of RBC units transfused, estimated blood loss, intraoperative transfusions, or venous thromboembolic events. Non-transfusion-related adverse events were similar between groups. The authors conclude that TXA did not reduce RBC transfusion in patients undergoing open radical cystectomy for bladder cancer (visual abstract).