Effect of intraoperative tranexamic acid use on postoperative bleeding in tumor replacement surgery

The aim of this study was to evaluate whether intraoperative intravenous (IV) tranexamic acid (TXA) reduces postoperative blood loss in patients undergoing tumor prosthesis surgery for primary or metastatic bone tumors. In this retrospective single-center study, 59 patients who underwent tumor prosthesis surgery between January 2013 and June 2024 were analyzed. Forty-two patients received a single intraoperative dose of 1 g IV TXA (TXA Group), while 17 did not receive TXA (Control Group). Demographic and clinical characteristics were recorded. Perioperative outcomes assessed were operative duration, hemoglobin (Hb) levels, drain output, and transfusion requirements during the postoperative 48 hours, and length of hospital stay. Multivariable linear regression and Firth’s penalized logistic regression were used to adjust for confounding factors. Baseline demographic and clinical characteristics were comparable between groups ( P  > .05). Operative duration was significantly longer in the TXA group ( P  < .001). Unadjusted analyses showed higher 48-hour drainage volumes and transfusion amounts in the TXA group ( P  = .021 and P  < .001, respectively), whereas Hb drop and transfusion rates did not differ significantly. After multivariable adjustment, TXA use was not independently associated with Hb decrease ( P  = .824), 48-hour drainage ( P  = .652), transfusion amount ( P  = .135), or transfusion requirement ( P  = .566). In patients undergoing tumor prosthesis surgery for primary or metastatic bone tumors, a single intraoperative dose of IV TXA was not associated with reduced postoperative Hb decline, drainage volume, or transfusion requirements. The higher crude transfusion and drainage volumes observed in the TXA group likely reflect longer operative times and increased surgical complexity rather than a direct effect of TXA.