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

Zaid, Harras B.; Yang, David Y.; Tollefson, Matthew K.; Frank, Igor; Winters, Jeffrey L.; Thapa, Prabin; Parker, William P.; Thompson, R. Houston; Karnes, R. Jeffrey; Boorjian, Stephen A.

doi:10.1016/j.urology.2016.02.044

Cited by 36 publications

(38 citation statements)

References 24 publications

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“…Open radical cystectomy (ORC) has definite curative effect, but there are many deficiencies, such as trauma, blood loss, slow recovery and so on [4]. Elderly patients, especially those over 75 years old, usually have more comorbidities, and therefore have a higher incidence of complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial

Chen

Zhou

2017

Oncotarget

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The aim of this study was to compare the morbidity, mortality, oncological results and quality of life between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) in the elderly patients over 75 years old. Between January 2012 and January 2015, 60 patients were recruited into this study, who were randomly assigned in a 1:1 ratio to either LRC or ORC group. Baseline patient characteristics, pathological factors, operative and postoperative characteristics, postoperative complications and survival data were retrospectively collected, analyzed and compared between the two groups. Patients in LRC group and ORC group had comparable baseline characteristics and pathological factors (all P > 0.05). LRC group required longer operative time (408.2 ± 76.9 vs. 311.7 ± 65.3 min, P = 0.000) and had less EBL (621.6 ± 100.7 vs. 1088.5 ± 109.4 ml, P = 0.000) compared with ORC group. The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9% vs. 28.6%, P = 0.041; 3.4% vs. 25%, P = 0.025). At a median follow-up of 28 months (range 12–48 months), the survival analysis showed that there were no significant differences between the LRC and ORC groups in overall survival (log-rank χ2 = 0.122; P = 0.726), or progress-free survival (log-rank χ2 = 0.153; P = 0.696). In conclusion, this study confirmed that LRC could achieve similar tumor treatment efficacy compared to ORC, with fewer perioperative complications and less blood loss. We suggest that LRC should be considered as the primary intervention for patients aged over 75 years old with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial

Chen

Zhou

2017

Oncotarget

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“…Crescenti et al [25] found in 200 patients undergoing radical retropubic prostatectomy, those treated with intraoperative TA had significantly lower mean intra-operative blood loss (1103 mL vs. 1335 mL, p=0.02) and transfusion rates (absolute risk reduction of 21%) compared to the placebo group with no significant difference between the incidence of thromboembolic events in the two groups. Similarly, Zaib et al [26] found in 103 patients who received a TA infusion during open radical cystectomy for bladder cancer that the post-operative blood transfusion rate was significant decreased in comparison to matched controls (31.1% vs. 57.7%, p<0.0001) and TA did not significantly increase the pre-operative venous thromboembolic rate (p=0.52).…”

Section: Antifibrinolytics In Elective Surgerymentioning

confidence: 86%

“…However, in patients under close observation in the peri-operative period on specialist wards with catheters in-situ the risk of clot retention with TA is hypothesised to be small. In addition, multiple studies that have utilised TA in urological procedures have not shown a significant increase in thromboembolic events with its use [25,26].…”

Section: Nephrectomymentioning

confidence: 99%

The Use of Peri-operative Tranexamic Acid and its Potential Applications to Urological Surgery

Nettleton¹,

Adimonye²,

Manley³

et al. 2018

TOUNJ

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Tranexamic acid has been shown to be an effective agent in reducing blood loss in various surgical procedures; however, there is a dearth of evidence for its use and potential side effects in urological surgical procedures. This review discusses the pathophysiology of tranexamic acid, its use in traumatic and surgical bleeding and the current evidence for its potential utilisation in urological surgery.

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“…On top of that, malignancy causes increased angiogenesis which in turn increases the chances of intra and postoperative hemorrhage. A retrospective review stated that patients who underwent open radical cystectomy had less frequent need for perioperative blood transfusion when they were given intravenous TA (25).…”

Section: Discussionmentioning

confidence: 99%

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

Siddiq¹,

Khalid²,

Mithani³

et al. 2017

jus

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Objective: Percutaneous nephrolithotomy (PCNL) is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA) would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI), stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb) and hematocrit (Hct) levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05). Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR) 4, while in TA group was 1.3 (IQR 7.8) (p=0.001). Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8) and in TA group was 2.4 (IQR 13) (p<0.001). Sixteen patients were transfused after surgery; 12 (75%) belonged to placebo group while 4 (25%) belonged to TA group (p=0.038). Hospital stay was not significantly different in both groups (p=0.177) with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.Amaç: Perkütan nefrolitotomi (PNL), 2 cm ve daha büyük böbrek taşları için en sık uygulanan prosedürdür. Perioperatif kanama en yaygın komplikasyon olup, istenmeyen sonuçların öngörülen önemli faktörüdür. Traneksamik asit (TA) gibi ucuz ve güvenli ilaçlarla önleme, nihayetinde gelecek kılavuz ilkeleri oluşturmak için temel taş haline dönüşebilir. Bu çalışmanın amacı, TA'nın PNL sırasında kan kaybını önlemede etkili olup olmadığını değerlendirmektir. Abstract Öz What's known on the subject? and What does the study add?Percutaneous nephrolithotomy is most frequently performed procedure for renal stones measuring 2 cm. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive safe drug like Tranexamic acid would ultimately turn out to be cornerstone for establishing future guidelines. Currently there is only one study published internationally highlighting this notion. Therefore this study will be beneficial for researchers in shaping the current practices.

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

Cited by 36 publications

References 24 publications

Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial

Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial

The Use of Peri-operative Tranexamic Acid and its Potential Applications to Urological Surgery

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

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