Pd34-03 Intraoperative Tranexamic Acid in Radical Cystectomy: Impact on Bleeding, Thromboembolism, and Cancer-Specific Survival

You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-03 INTRAOPERATIVE TRANEXAMIC ACID IN RADICAL CYSTECTOMY: IMPACT ON BLEEDING, THROMBOEMBOLISM, AND CANCER-SPECIFIC SURVIVAL Mohamed E. Ahmed, Jack R. Andrews, Ahmed Mahmoud, Prabin Thapa, Mark D. Tyson, Abhinav Khanna, Paras H. Shah, Vidit Sharma, R. Houston Thompson, Stephen A. Boorjian, Igor Frank, Matthew K. Tollefson, and R. Jeffrey Karnes Mohamed E. AhmedMohamed E. Ahmed , Jack R. AndrewsJack R. Andrews , Ahmed MahmoudAhmed Mahmoud , Prabin ThapaPrabin Thapa , Mark D. TysonMark D. Tyson , Abhinav KhannaAbhinav Khanna , Paras H. ShahParas H. Shah , Vidit SharmaVidit Sharma , R. Houston ThompsonR. Houston Thompson , Stephen A. BoorjianStephen A. Boorjian , Igor FrankIgor Frank , Matthew K. TollefsonMatthew K. Tollefson , and R. Jeffrey KarnesR. Jeffrey Karnes View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perioperative blood transfusion has been reported in >50% of patients undergoing Radical cystectomy (RC). Perioperative blood transfusion in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for perioperative blood transfusion. Here, we seek to investigate the impact of intraoperative TXA on risk of perioperative bleeding and VTE in patients undergoing RC. We also investigate its long-term impact on cancer specific survival outcomes. METHODS: We queried the Mayo Clinic Radical Cystectomy registry and identified all RC performed between 1990-2021. Primary outcomes include risk of peri-operative bleeding, need for blood transfusion, and risk of VTE. Secondary outcomes include impact of using TXA on cancer specific survival outcomes. RESULTS: Among 2862 patients who underwent RC in our institution between 1990-2021, 479 received TXA intraoperatively (Group A) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (Group B). Group A experienced less EBL intraoperatively (mean difference in EBL was 144 cc, p-value 0.03) and were less likely to need PBT (31% versus 49%, p-value 0.05). Figure 1 demonstrates K-M curve for CSS between group A and B; favoring patients who received TXA. In univariable and multivariable analyses of factors impacting CSS (Table1), node positive disease, pT2-T4, peri-operative blood transfusion were associated with poor CSS while use of TXA was associated with improved CSS outcomes. CONCLUSIONS: The use of intraoperative TXA in RC was associated with a significant reduction in EBL and perioperative blood transfusion without increased risk of VTE. Interestingly, TXA was independently associated with improved CSS. While the underlying mechanism is not well understood, these findings warrant further prospective investigation. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e718 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mohamed E. Ahmed More articles by this author Jack R. Andrews More articles by this author Ahmed Mahmoud More articles by this author Prabin Thapa More articles by this author Mark D. Tyson More articles by this author Abhinav Khanna More articles by this author Paras H. Shah More articles by this author Vidit Sharma More articles by this author R. Houston Thompson More articles by this author Stephen A. Boorjian More articles by this author Igor Frank More articles by this author Matthew K. Tollefson More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement PDF downloadLoading ...