PURPOSE Perioperative blood transfusion has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, perioperative blood transfusion (PBT) in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and venous thromboembolism (VTE) in patients undergoing RC. We also investigate its long-term impact on overall survival (OS) and cancer-specific survival (CSS) outcomes. MATERIALS AND METHODS We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RC performed for bladder cancer between 1990 and 2021. Primary outcomes assessed include the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS. RESULTS Of 2862 patients with complete available data, 468 received TXA (TXA recipient) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (TXA nonrecipient). TXA recipients experienced less estimated blood loss intraoperatively (median of 600 vs 650) cc and were less likely to need PBT (31% vs 50%, P value < .001) compared with TXA nonrecipients. There was no difference between groups in deep venous thrombosis and pulmonary embolism rates within 90 days of RC. In the adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, perioperative blood transfusion was associated with poor OS and CSS (P value < .001). CONCLUSIONS TXA use was associated with a significant reduction in estimated blood loss and PBT without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved OS as well as CSS. However, in multivariable analyses, TXA itself was not independently associated with improved OS or CSS; instead, PBT was. Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes.

中文翻译：

---

根治性膀胱切除术中的术中氨甲环酸：对出血、血栓栓塞和生存结局的影响。


背景 > 据报道，50% 的接受根治性膀胱切除术 （RC） 的患者围手术期输血。不幸的是，接受 RC 的患者围手术期输血与不良的肿瘤学结果有关。氨甲环酸 （TXA） 的使用已被提议以减少围手术期输血的需求。在这里，我们试图研究术中 TXA 对根治性膀胱切除术 （RC） 患者围手术期出血和 VTE 风险的影响。我们还研究了其对总生存期 （OS） 和癌症特异性生存结果 （CSS） 的长期影响。方法 我们查询了前瞻性维护的 Mayo Clinic 根治性膀胱切除术登记库，并确定了 1990-2021 年间针对膀胱癌进行的所有 RC。评估的主要结局包括围手术期出血风险、输血需求和 VTE 风险。次要结局包括使用 TXA 对 OS 和 CSS 的影响。结果 在具有完整可用数据的 2862 例患者中，468 例接受了 TXA （TXA 受体），并在年龄、新辅助化疗、病理分期和术前血红蛋白方面与未接受 TXA 的组 （TXA -非受体） 1：1 匹配。与非 TXA 接受者相比，TXA 受者术中估计失血量 （EBL） 较少 （中位数为 600 对 650） cc，并且不太可能需要 PBT （31% 对 50%，p 值 <0.001）。RC 后 90 天内深静脉血栓形成 （DVT） 和肺栓塞 （PE） 发生率在各组之间没有差异。在调整后的生存模型中，TXA 的使用与对 OS 或 CSS 的显着影响不独立相关。然而，围手术期输血与 OS 和 CSS 不良相关 （p 值 <0.001）。 结论 TXA 的使用与 EBL 和围手术期输血的显着减少相关，而不增加 VTE 的风险。在单变量分析中，我们观察到 TXA 使用与提高总生存期以及癌症特异性生存期之间存在关联。然而，在多变量分析中，TXA 本身与总生存期 （OS） 或癌症特异性生存期 （CSS） 的改善并不独立相关;相反，围手术期输血是。需要进一步的研究来探索减少围手术期输血的策略及其对生存结局的影响。