Evidence map›Paper›PMID 40965659›Full record

SynthesisWorld journal of urology2025

Tranexamic acid in radical cystectomy: a systematic review and meta-analysis of efficacy and safety.

Maurin Helen Mangold, Victoria Luise Simone Wieland, Maurizio Grilli, Alexander Studier-Fischer, Caelán Max Haney-Aubert, Niklas Westhoff, Maurice Stephan Michel, Luisa Egen, Karl-Friedrich Kowalewski

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Maurin Helen MangoldDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Victoria Luise Simone WielandDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Maurizio GrilliMedical Library, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Alexander Studier-FischerDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Caelán Max Haney-AubertDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Niklas WesthoffDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Maurice Stephan MichelDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Luisa EgenDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Karl-Friedrich KowalewskiDepartment of Urology and Urosurgery, Medical Faculty Mannheim at Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. karl-friedrich.kowalewski@umm.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRadical cystectomy (RC) is a high-risk procedure, associated with significant bleeding and high risk of perioperative blood transfusion (PBT), which may limit clinical and oncological outcomes. Tranexamic acid (TXA), an antifibrinolytic agent, effectively reduces bleeding in various surgical settings; however, its role in RC remains understudied. This systematic review and meta-analysis evaluates the efficacy and safety of TXA in RC patients.

methodsA systematic search of CENTRAL, PubMed, Embase, and Web-of-Science was conducted, including studies published between January 2013 and January 2025. Four studies (one randomised controlled trial (RCT) and three retrospective cohort studies) met inclusion criteria. Data were pooled using random-effects meta-analysis. Risk of bias was assessed using ROBINS-I and RoB-2, and certainty of evidence was evaluated using GRADE.

resultsTXA was associated with a significant reduction in overall PBT (odds ratio (OR) 0.48, 95%-confidence interval (CI) 0.27–0.82; p = 0.008), though the only RCT included failed to identify this trend. Estimated blood loss was numerically reduced in the TXA group, but did not reach statistical significance (mean difference − 36.8 mL; 95%-CI -78.1-4.6; p = 0.08). Notably, TXA did not increase the incidence of venous thromboembolism (OR 1.49, 95%-CI 0.86–2.57; p = 0.16). Key limitations include substantial heterogeneity between studies (I² = 78% for PBT outcome), varying TXA dosing protocols, and the predominance of retrospective studies.

conclusionTXA may reduce PBT requirements in RC without increasing thromboembolic risk. Further research is needed to confirm these findings, refine dosing protocols, and assess efficacy in minimally invasive RC.

Indexed as

Antifibrinolytic AgentsBlood Loss, SurgicalCystectomyTranexamic AcidUrinary Bladder NeoplasmsBlood TransfusionHumansTreatment OutcomeAntifibrinolytic AgentsTranexamic AcidBlood transfusionCystectomyTranexamic acidVenous thromboembolism

Identifiers

PMID40965659
PMCPMC12446414

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.