Blood transfusion and hemostatic agents used during radical cystectomy

Punjani, Nahid; Lavallée, Luke T.; Momoli, Franco; Fergusson, Dean; Witiuk, Kelsey; Mallick, Ranjeeta; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H.

doi:10.5489/cuaj.1002

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…In recent years, numerous attempts have been made to reduce blood loss during RC. Several methods including hemostatic agents (topical and systemic), 20 adding epidural anesthesia to general anesthesia 21 or new technical devices such as the bipolar apparatus (LigaSure), harmonic scalpel or a stapling apparatus and laparoscopic surgeries were suggested as useful tools to lessen blood loss and lower the need for transfusions. 22,23 However, although advances in surgical techniques have led to the reduced transfusion rates in some cystectomy series, open RC remains associated with a rather high transfusion rate.…”

Section: Bladder Cancermentioning

confidence: 99%

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Abu-Ghanem

Ramon

2019

Therapeutic Advances in Urology

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The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.

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Section: Bladder Cancermentioning

confidence: 99%

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Abu-Ghanem

Ramon

2019

Therapeutic Advances in Urology

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“…In 2011, urologists who specialize in cancer treatment (members of the Society of Urologic Oncology) were surveyed about the methods they used to prevent blood loss during radical cystectomy [ 11 ]. Respondents were asked about their use of systematic techniques, systemic drugs, and topical agents to reduce blood loss and prevent blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized Controlled Trial

Breau

Lavallée

Cnossen

et al. 2018

Trials

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BackgroundRadical cystectomy for bladder cancer is associated with a high risk of needing red blood cell transfusion. Tranexamic acid reduces blood loss during cardiac and orthopedic surgery, but no study has yet evaluated tranexamic acid use during cystectomy.MethodsA randomized, double-blind (surgeon-, anesthesiologist-, patient-, data-monitor-blinded), placebo-controlled trial of tranexamic acid during cystectomy was initiated in June 2013. Prior to incision, the intervention arm participants receive a 10 mg/kg loading dose of intravenously administered tranexamic acid, followed by a 5 mg/kg/h maintenance infusion. In the control arm, the patient receives an identical volume of normal saline that is indistinguishable from the intervention. The primary outcome is any blood transfusion from the start of surgery up to 30 days post operative. There are no strict criteria to mandate the transfusion of blood products. The decision to transfuse is entirely at the discretion of the treating physicians who are blinded to patient allocation. Physicians are allowed to utilize all resources to make transfusion decisions, including serum hemoglobin concentration and vital signs. To date, 147 patients of a planned 354 have been randomized to the study.DiscussionThis protocol reviews pertinent data relating to blood transfusion during radical cystectomy, highlighting the need to identify methods for reducing blood loss and preventing transfusion in patients receiving radical cystectomy. It explains the clinical rationale for using tranexamic acid to reduce blood loss during cystectomy, and outlines the study methods of our ongoing randomized controlled trial.Trial registrationsCanadian Institute for Health Research (CIHR) Protocol: MOP-342559; ClinicalTrials.gov, ID: NCT01869413. Registered on 5 June 2013.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2626-3) contains supplementary material, which is available to authorized users.

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The Effects of Lysine Analogs During Pelvic Surgery: A Systematic Review and Meta-Analysis

Breau

Kokolo

Punjani

et al. 2014

Transfusion Medicine Reviews

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Blood transfusion and hemostatic agents used during radical cystectomy

Cited by 5 publications

References 21 publications

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized Controlled Trial

The Effects of Lysine Analogs During Pelvic Surgery: A Systematic Review and Meta-Analysis

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