“We need new solutions to reduce blood loss during bladder removal surgery. This study proves that routine use of tranexamic acid is not effective, so we need to explore other options,” says Dr. Rodney Breau.The largest clinical trial of its kind found a common blood clotting drug did not reduce blood transfusions during radical cystectomy for bladder cancer. Radical cystectomy is a complex surgery where the urinary bladder and adjacent organs are removed and urine flow is redirected using parts of the intestine. This major surgery has one of the highest risks of blood loss and need for blood transfusion.
The blood clotting drug tranexamic acid has been found to reduce blood loss during heart and orthopedic surgery, but it was unclear if the same benefits would occur during major cancer surgery. To find out, Drs. Rodney Breau and Dean Fergusson led a national trial comparing an IV infusion of tranexamic acid given during radical cystectomy compared to a saline solution placebo.
After recruiting 344 patients from 10 Canadian hospitals, the team found the drug had no effect on blood loss or transfusion – 37 per cent of patients in both groups needed transfusion. Their results were published in JAMA Surgery.
“We need new solutions to reduce blood loss during bladder removal surgery. This study proves that routine use of tranexamic acid is not effective, so we need to explore other options,” says Dr. Breau, senior scientist and urologist at The Ottawa Hospital and professor at the University of Ottawa.
Authors: Rodney H. Breau, Luke T. Lavallée, Ilias Cagiannos, Franco Momoli, Gregory L. Bryson, Salmaan Kanji, Christopher Morash, Alexis F. Turgeon, Ryan Zarychanski, Brett L. Houston, Daniel I. McIsaac, Ranjeeta Mallick, Greg A. Knoll, Girish Kulkarni, Jonathan Izawa, Fred Saad, Wassim Kassouf, Vincent Fradet, Ricardo Rendon, Bobby Shayegan, Adrian Fairey, Darrel E. Drachenberg, Dean Fergusson.
Core Resources: Ottawa Methods Centre
Funding: This trial was funded by the Canadian Institute for Health Research.
The Ottawa Hospital is a leading academic health, research and learning hospital proudly affiliated with the University of Ottawa and supported by The Ottawa Hospital Foundation.
