Abstract
Background
Radical cystectomy is associated with substantial blood loss and transfusion requirements, raising the potential role of tranexamic acid (TXA) to mitigate these risks. However, its effectiveness and safety in this context remain to be fully established.Methods
A comprehensive search of PubMed, Embase, Web of Science, and Scopus from inception to May 19, 2025, identified studies involving adult patients undergoing cystectomy (partial or radical) comparing TXA with placebo, no treatment, or alternative hemostatic agents.Results
Four studies (1 RCT, 3 cohort studies) with sample sizes ranging from 64 to 936 patients were included. TXA significantly reduced estimated blood loss (SMD = -0.11; 95% CI: -0.21, -0.01; p = 0.03) and total transfusion volume (SMD = -0.28; 95% CI: -0.54, -0.02; p = 0.04). The odds of receiving any transfusion decreased by 52% (OR = 0.48; 95% CI: 0.30, 0.77; p = 0.002), with postoperative transfusion reduction particularly notable (OR = 0.32; 95% CI: 0.16, 0.63; p Conclusions
Tranexamic acid appears effective in reducing blood loss and transfusion requirements during cystectomy, with no evidence of increased VTE risk and a potential survival benefit.