Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Abstract

In cancer patients undergoing surgery, tumor biology and anticancer treatments can increase the risk of perioperative bleeding and blood transfusions. Notably, blood transfusions can be potentially associated with an increased risk of life-threatening immune responses, acute lung injury, postoperative infections, and thromboembolism. Moreover, the link between perioperative transfusion and increased risk of cancer recurrence cannot be excluded. On the other hand, cancer patients have an increased risk of thromboembolism due to cancer itself and antineoplastic systemic treatments including chemotherapy and anti-angiogenic drugs. In this complex scenario, effective and safe strategies aimed at the prevention of blood transfusions are warranted. This narrative review addresses the efficacy, and the safety of the synthetic antifibrinolytic agent tranexamic acid (TXA) when used perioperatively in cancer surgery. Although in not oncologic surgery the use of TXA has been extensively studied, in the setting of cancer patients requiring surgery, the evidence is scarce. An overview of the ongoing clinical research is also provided.

Local Infiltration of Tranexamic Acid in Breast Reduction for Symptomatic Macromastia

“…Again, this could be explained by TXA-mediated inhibition of the fibrinolytic cascade and its immunomodulatory effects, resulting in reduced infection rates as seen in the cardiac surgery literature. 20,21,23,24 However, like a retrospective review of TXA use in breast reduction patients conducted by Weissler et al, 19 we found no significant impact on seromas and hematomas with TXA use. In accordance with the literature, we found no significant increase in overall complications from TXA use.…”

“…Furthermore, no patients developed suture granulomas in the TXA group in comparison to 5 patients in the non- TXA group. Again, this could be explained by TXA-mediated inhibition of the fibrinolytic cascade and its immunomodulatory effects, resulting in reduced infection rates as seen in the cardiac surgery literature 20,21,23,24 . However, like a retrospective review of TXA use in breast reduction patients conducted by Weissler et al, 19 we found no significant impact on seromas and hematomas with TXA use.…”

“…We found a lower incidence of T-junction dehiscence and suture granuloma in the group of patients who had received TXA ( P = 0.016 and P = 0.05, respectively). This could be explained by TXA's ability to inhibit plasmin formation and subsequently reduce the activation of monocytes and neutrophils 20 and inhibit complement activation, 21,22 leading to an overall reduction in inflammation and edema. The resulting effect of this is decreased suture line tension, which decreases the risk of dehiscence.…”

Untargeted metabolomic study of lung cancer patients after surgery with curative intent: possible metabolites of good prognosis, intervention failure and recurrence

“…In this sense, only tranexamic acid (TXA) showed a good value of AUC (0.81) in the ROC analysis. TXA has been reported to prevent blood clot breakdown and thus bleeding since it is an analog of lysine which blocks the interaction with brin and the conversion of plasminogen to plasmin [22]. Also, a family of compounds related with 4-(3-pyridyl)-butanoic acid such as 4-hydroxy-4-(3-pyridyl)butanoic acid are considered potent carcinogenic compounds related with tobacco [23].…”

Intravenous tranexamic acid reduces complications following surgical treatment of pathologic fractures of the lower extremity

“…Currently, the literature regarding TXA utilization for neoplastic diseases of the lower extremity is limited to three studies 13–15 . As such, orthopedic oncologic surgeons may be hesitant to administer IV TXA before surgery for neoplastic pathologic fractures of the lower extremity due to the concern that the antifibrinolytic properties of TXA inhibiting clot dissolution may exacerbate the risk of VTE in these hypercoagulable individuals 13,14,16,17 . Thus far, this has yet to be proven.…”