Impact on blood loss and transfusion rates following administration of tranexamic acid in major oncological abdominal and pelvic surgery: A systematic review and meta‐analysis

Abstract

Background and Objectives Major bleeding and receiving blood products in cancer surgery are associated with increased postoperative complications and worse outcomes. Tranexamic acid (TXA) reduces blood loss and improves outcomes in various surgical specialities. We performed a systematic review and meta‐analysis to investigate TXA use on blood loss in elective abdominal and pelvic cancer surgery. Methods A literature search was performed for studies comparing intravenous TXA versus placebo/no TXA in patients undergoing major elective abdominal or pelvic cancer surgery. Results Twelve articles met the inclusion criteria, consisting of 723 patients who received TXA and 659 controls. Patients receiving TXA were less likely to receive a red blood cell (RBC) transfusion (p < 0.001, OR 0.4 95% CI [0.25, 0.63]) and experienced less blood loss (p < 0.001, MD −197.8 ml, 95% CI [−275.69, −119.84]). The TXA group experienced a smaller reduction in haemoglobin (p = 0.001, MD –0.45 mmol/L, 95% CI [−0.73, −0.18]). There was no difference in venous thromboembolism (VTE) rates (p = 0.95, OR 0.98, 95% CI [0.46, 2.08]). Conclusions TXA use reduced blood loss and RBC transfusion requirements perioperatively, with no significant increased risk of VTE. However, further studies are required to assess its benefit for cancer surgery in some sub‐specialities.

Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study

“…In agreement with this study, a systematic review, including 723 patients who received TA and 659 control patients who underwent elective abdominal or pelvic cancer surgeries, showed a reduction in blood loss and transfusion rates without any remarkable increase in postoperative venous thromboembolism (VTE) with TA use (25).…”

“…Despite the promising results, this combined modality has a high rate of complications (24). It is a lengthy procedure that involves extensive exploration and resection, with a large surgical field, and often requires blood transfusion (24,25).…”

A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery

“…The application of TXA for hemostatic purposes in orthopaedic (Groene et al 2021 ; Wong et al 2021 ; Goldstein et al 2022 ), oncological (Fowler et al 2022 ; Liechti et al 2022 ), and cardiac surgery (Houston et al 2020 ; Chunmei et al 2022 ) is well documented. However, the use of TXA in aesthetic plastic surgery remains controversial due to the scarcity and quality of the studies and the wide range of aesthetic plastic surgery procedures.…”

“…Although it has been approved by the US Food and Drug Administration (FDA) for the treatment of haemophilia, studies are ongoing investigations of its prescription for other medical uses. Despite its use in The application of TXA for hemostatic purposes in orthopaedic (Groene et al 2021;Wong et al 2021;Goldstein et al 2022), oncological (Fowler et al 2022;Liechti et al 2022), and cardiac surgery (Houston et al 2020;Chunmei et al 2022) is well documented.…”

The impact of tranexamic acid on perioperative outcomes in urological surgeries: A systematic review and meta-analysis

“…14,15 Even in oncologic surgery, in which the patient population is at a heightened risk of VTE, studies suggest no increase in thrombotic events. 16,17 The utility of TXA in urology remains open-ended, with multiple ongoing randomized controlled trials (RCTs) investigating its application in a variety of urologic surgeries. This may be due to the relatively low risk of clinically significant bleeding associated with common urologic procedures.…”