Can tranexamic acid in irrigation fluid reduce blood loss during monopolar transurethral resection of the prostate? A randomised controlled trial
Tawfick A, Mousa W, El-Zhary AF, Saafan AM
Arab journal of urology. 2022;20(2):94-99
OBJECTIVE To assess the efficacity and safety of using tranexamic acid (TXA) in the irrigation solution during transurethral resection of the prostate (TURP). PATIENTS AND METHODS A total of 50 patients undergoing TURP for benign prostatic hyperplasia were prospectively randomised in a controlled clinical trial and distributed into two groups. Group A received 0.1% TXA 1000 mg (10 mL) in 1 L of irrigation solution of sterile wash (glycine) during surgery, while Group B received 10 mL distilled water (placebo) in 1 L of irrigation solution of sterile wash (glycine) during surgery. At the end of surgery, a three-way catheter was inserted in the bladder. Group A received local 500 mg of TXA (5 mL), which was dissolved in 100 mL of normal saline solution, while Group B received distilled water (5 mL) dissolved in 100 mL of normal saline solution after which the catheter was clamped. The serum haemoglobin (Hb) concentration, haematocrit (HCT), blood loss volume, Hb concentration in the irrigation fluid, and bladder irrigation volumes were compared between the two groups at three time-points: preoperatively and at 4- and 24-h postoperatively. Coagulation function, complications, thromboembolic events, quality of endoscopic view, surgery duration, and hospital stay were also noted. RESULTS Group A had significantly lower blood loss intraoperatively, and at 4- and 24-h postoperatively compared to the control group (P < 0.05). The serum Hb concentration, HCT, Hb concentration in the irrigation fluid, and bladder irrigation volumes were significantly lower in the TXA group vs the control group (P < 0.001). The shortening of the surgery duration and improvement in the quality of the endoscopic view were significantly noted in the TXA group (P = 0.001). However, no thromboembolic events occurred in either group. CONCLUSION The use of TXA in the irrigation fluid during TURP and injection into the bladder postoperatively can reduce blood loss and the need for blood transfusion without increasing the risk of thrombosis.
The role of tranexamic acid in reducing bleeding during transurethral resection of the prostate: An updated systematic review and meta-analysis of randomized controlled trials
Pranata FH, Kloping YP, Hidayatullah F, Rahman ZA, Yogiswara N, Rahman IA, Febriansyah NA, Soebadi DM
Indian journal of urology : IJU : journal of the Urological Society of India. 2022;38(4):258-267
INTRODUCTION Transurethral resection of the prostate (TURP) is regarded as the current gold standard surgical intervention for benign prostatic hyperplasia (BPH). However, this procedure is associated with significant chances of intraoperative and postoperative bleeding. Several studies have reported the role of tranexamic acid in prostatic surgeries, but, its role in TURP is still unclear. This review aims to evaluate the role of tranexamic acid in reducing the blood loss during TURP. MATERIALS AND METHODS A systematic search was performed on Medline, Scopus, Embase, and Cochrane, up to December 2021. Relevant randomized controlled trials (RCTs) evaluating the role of tranexamic acid in TURP were screened using our predefined eligibility criteria. Data were expressed as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs). All analyses were performed using RevMan 5.4 (Cochrane Collaboration, UK). RESULTS Six trials were included in this meta-analysis, comprising of 582 patients with BPH who underwent TURP. The meta-analysis revealed an insignificant difference in the rate of blood transfusion (OR 0.68, 95% CI 0.34, 1.34, P = 0.27) but, a significantly lower amount of blood loss and a lower reduction in the hemoglobin (Hb) levels in the patients receiving tranexamic acid as compared to the control group (MD - 127.03, 95% CI - 233.11, -20.95, P = 0.02; MD - 0.53, 95% CI - 0.84, -0.22, P < 0.01; respectively). Also, the operative time (P = 0.12) and the length of hospitalization (P = 0.59) were similar between the two groups. CONCLUSION The administration of tranexamic acid was not found to be effective in reducing the need for blood transfusion, the operative time, and the length of hospitalization during the TURP. However, it could reduce the amount of blood loss and the fall in the Hb levels.
Can high-dose tranexamic acid have a role during transurethral resection of the prostate in large prostates? A randomised controlled trial
Samir M, Saafan AM, Afifi RM, Tawfick A
Arab journal of urology. 2022;20(1):24-29
OBJECTIVES To assess the efficacy and safety of high-dose tranexamic acid (TXA) during bipolar transurethral resection of the prostate (B-TURP) in patients with large prostates compared to placebo. PATIENTS AND METHODS From February 2018 to May 2020, 204 patients with enlarged prostates of 80-130 g and in need of surgical intervention were randomised into two groups. Patients in Group A underwent B-TURP and received TXA as an intravenous loading dose of 50 mg/kg over 20 min before induction of anaesthesia followed by a maintenance infusion of 5 mg/kg/h until resection was completed. The patients in Group B (placebo) received a saline infusion of a similar volume. RESULTS There was highly significant drop in haemoglobin in the placebo group at 4- and 24-h postoperatively compared with the TXA group (P < 0.001). However, there was no significant difference in the blood transfusion rate between the two groups with five patients (5.5%) in the placebo group and four (4.2%) in the TXA group requiring a transfusion (P = 0.74). The procedural time was significantly less in the TXA group vs the control group, at a mean (SD) of 79.93 (22.18) vs 90.91 (21.4) min (P = 0.001). Also, the intraoperative irrigation fluid volume and postoperative irrigation duration were significantly less in the TXA group vs the control group, at a mean (SD) of 19.21 (3.13) vs 23.05 (3.8) L and 14.75 (5.15) vs 18.33 (5.96) h, respectively (P = 0.001). Catheterisation and hospital stay durations were comparable between both groups (P = 0.384 and P = 0.388, respectively). No complications were recorded with use of high-dose TXA. CONCLUSION High-dose TXA was effective in controlling blood loss during B-TURP in patients with large prostates, with no adverse drug reactions.
Tranexamic Acid Does Not Improve Outcomes of Holmium Laser Enucleation of the Prostate (HoLEP): A Prospective Randomized, Controlled Trial
Assmus MA, Lee MS, Helon JW, Krambeck A
Journal of endourology. 2022
INTRODUCTION Tranexamic acid (TXA) is a clot promoting agent utilized during orthopedic procedures to decrease bleeding. Urologists have demonstrated benefits of TXA in percutaneous surgery. Our objective was to assess safety and efficacy of single-dose TXA on same-day HoLEP outcomes. METHODS From September 2021 to January 2022, we prospectively randomized 110 patients undergoing HoLEP to either 1 gram of TXA after induction or no treatment. IRB approval (STU00215134) and registry with ClinicalTrials.gov (NCT05082142) was obtained prior to enrollment. Primary outcome was rate of successful same day discharge (SDD). Secondary outcomes included transfusion rate, same day catheter removal, length of stay (LOS), and 90-day complications. Power analysis determined 110 patients should be enrolled to detect a 25% difference in SDD rate. RESULTS There was no difference in patient demographic and prostate features between control (n=55) and TXA groups (n=55) (all p>0.05). The overall rate of successful SDD was not different between control and TXA groups (49/55 (89%) vs. 51/55 (93%), p=0.74). Median LOS (hh:mm) was not different between groups (03:07 vs. 02:50, p=0.23) with only 3/110 (2.7%) having a LOS >24hours. Successful same day catheter removal occurred in 99/110 (90%) patients with no difference between groups (49/55 vs. 50/55, p=0.99). There was no difference in operative parameters (time, energy, specimen weight) and postoperative complications between groups (all p>0.05). No patients required transfusions and there were no major 90-day complications related to surgery (Clavien-dindo ≥IIIb). CONCLUSION TXA administration is safe but did not impact same day discharge after HoLEP.
Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach
Gupta A, Priyadarshi S, Vyas N, Sharma G
Urology annals. 2021;13(3):238-242
BACKGROUND Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic enlargement; however, hemorrhage still remains one of the major complications. OBJECTIVE The primary aim of this study was to evaluate the effect of tranexamic acid (TXA) in reducing intraoperative blood loss and need for blood transfusion. Secondary parameters compared were operating time, volume of irrigation fluid used, and reduction in hemoglobin concentration. SUBJECTS AND METHODS A total of 70 eligible patients undergoing TURP were randomized based on computer generated table into two groups. The study group (1) received IV TXA 500 mg after induction of anesthesia and 500 mg in each irrigation fluid bottle (dual mode) and the control group (2) received none. RESULTS The mean age (68.20 vs. 66.5 years), prostate size (57 vs. 51 g), and preoperative hemoglobin (13.3 vs. 13.5 g/dl) were similar between the groups. Intraoperative blood loss in the TXA group was found to be significantly reduced (174.60 ± 125.38 ml vs. 232.47 ± 116.8; P = 0.04). Blood transfusion was required in 2.8% of cases as compared to 14.2% in controls. Operating time, volume of irrigation fluid, and postoperative reduction of hemoglobin were not significant between the groups. No complications were observed in both groups. CONCLUSION In this study, we observed that TXA, when used as a combination of Intravenous and topical route, effectively reduced intra-operative blood loss and the need for transfusion.
Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis
Wang Z, He X, Bai Y, Wang J
J Int Med Res. 2020;48(4):300060520917563
OBJECTIVE A systematic review and meta-analysis was conducted to explore the efficacy of tranexamic acid (TXA) in reducing transfusion events in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases from January 1980 to October 2019 were searched for randomized controlled trials (RCTs) that assessed TXA efficacy in reducing transfusion events during PCNL. Intervention treatments include using TXA compared with placebo (or no intervention) for patients who underwent PCNL. The search strategy and study selection process were managed in accordance with the PRISMA statement. RESULTS Six RCTs are included in the meta-analysis. Overall, TXA intervention groups showed a significant reduction in blood transfusion events (RR = 0.34; 95% confidence interval [CI] = 0.19 to 0.62), hemoglobin decrease (MD = -0.80; 95% CI = -1.32 to -0.28), operative time (MD = -12.62; 95% CI = -15.62 to -9.61), and length of hospital stay (MD = -0.73; 95% CI = -1.36 to -0.10) compared with control groups after PCNL. However, TXA had no substantial impact on the rate of stone clearance (RR = 1.10; 95% CI = 1.00 to 1.21). CONCLUSIONS TXA can effectively reduce the transfusion rate and blood loss during PCNL.
Tranexamic acid is beneficial for reducing perioperative blood loss in transurethral resection of the prostate
Meng QQ, Pan N, Xiong JY, Liu N
Experimental and therapeutic medicine. 2019;17(1):943-947
The aim of this randomized controlled trial was to evaluate the effect of tranexamic acid (TXA) on postoperative blood loss during transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). A total of 60 patients with BPH and undergoing TURP were randomized into TXA and control groups. Patients were intravenously administered 1 g TXA or placebo (0.9% sodium chloride solution), respectively, after the induction of anesthesia for TURP. Intraoperative and postoperative bladder irrigation volumes and blood loss volumes were compared between the two groups. Coagulation function (measured by prothrombin, activated partial thromboplastin and thrombin time and fibrinogen levels) was measured before the operation and at 4 h post-operation. Complications from thromboembolic events, such as lower-limb and pulmonary embolisms, were also noted. The TXA group had significantly decreased blood loss intraoperatively and at 4 h postoperatively compared with the control group (P<0.05). The 24 h postoperative blood loss and coagulation function of the two groups were not significantly different. No thromboembolic events or other complications occurred in either group. In conclusion, a preoperative single dose of TXA was indicated to reduce perioperative blood loss in TURP without a notable increase in thrombosis risk.
Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial
Jendoubi A, Malouch A, Bouzouita A, Riahi Y, Necib H, Ghedira S, Houissa M
Progres En Urologie : Journal De L'association Francaise D'urologie Et De La Societe Francaise D'urologie. 2017;27((16):):1036-1042
BACKGROUND Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37+/-0.69 vs. 1.72+/-1.23g/dL respectively, P=0.256) or TURBT (1.15+/-0.95 vs. 1.07+/-0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE 4.
Efficacy of a short prophylaxis with tranexamic acid on hemostasis during transrectal prostate biopsy in patients taking oral anti-platelet treatment
Dell'Atti L, Stefano P, Gaetano C, Carmelo I
Journal of B.U.On... 2016;21((3)):680-4.
PURPOSE To assess the efficacy of a short prophylaxis with tranexamic acid in reducing blood loss during transrectal ultrasound-guided prostate biopsy (TRUSBx) in patients taking oral anti-platelet therapy and to prospectively compare this approach with patients without oral prophylaxis. METHODS A total of 359 consecutive patients taking chronic low dose aspirin were enrolled in this prospective study. Before TRUSBx all patients were randomly assigned into two groups; a short oral prophylaxis with tranexamic acid 500 mg orally, taken one hour before the procedure (group A, N:178 ) and those without oral prophylaxis (group B, N:181). Patients were asked about complications, their frequency, severity of bleeding (hematuria, hematospermia, rectal bleeding) on a 0-5 scale, with 0 representing absence of bleeding and 5 very severe bleeding. RESULTS No significant differences were noted between the two groups in radiation to age, preoperative PSA level, prostate volume, biopsy numbers, and Gleason score. There were no severe bleeding complications (grade 5) recorded in both groups. The study revealed significant differences in the incidence of hematuria (p<0.001) and rectal bleeding (p<0.002) between the groups. Patients in group A (16.9%) experienced fewer hematuria and rectal bleeding episodes than did the group B patients (31.5%). The number of sexually active men still reporting hematospermia was 16.6% in group A and 19.4% in group B, with no statistical difference (p=0.32). CONCLUSION The continued use of anti-platelet agents in patient undergoing TRUSBx does not increase the incidence of mild bleeding complications, if these are associated with a short-term tranexamic acid treatment.
Local administration of tranexamic acid during prostatectomy surgery: effects on reducing the amount of bleeding
Pourfakhr P, Gatavi E, Gooran S, Etezadi F, Khajavi MR, Pourroustaei R, Shariat Moharari R, Najafi A
Nephrourology Monthly. 2016;8((6)):e40409.
BACKGROUND One of the issues in prostatectomy surgery is bleeding. Although tranexamic acid (TRA) is an antifibrinolytic agent for reducing bleeding, controversies surround its use. OBJECTIVES In this study, the effect of local administration of TRA on reducing bleeding during prostatectomy surgery was evaluated. METHODS A total of 186 patients who underwent prostatectomy surgery were assessed in this clinical trial study. Patients were divided randomly into two groups. After prostate removal, TRA (500 mg TRA with 5 mL total volume) to the intervention group and normal saline to the control group were sprayed with the same volume. At the end of surgery, the prescribed blood bags were measured and recorded. Hemoglobin and platelet levels were recorded 6 hours after the test. Moreover, the amounts of blood inside the blood bags in the first 24 hours, the second 24 hours, and the total length of hospital stay were recorded and compared in each group. RESULTS By comparing the measured values before and after surgery, we found that the amounts of hemoglobin, hematocrit, and platelet decreased. The mean blood loss in the intervention group was recorded at 340 mL and that in the control group was 515 mL. The maximum bleeding in the control group was almost twice as much as that in the intervention group. Blood loss in the intervention group with the administration of TRA was significantly lesser than that in the control group (P = 0.01). The decrease in platelet level in the intervention group was significantly lower than that in the control group (P = 0.03). CONCLUSIONS The present study showed that local administration of TRA significantly reduces bleeding after prostatectomy surgery and is effective in preventing postoperative hemoglobin decrease. IS 2251-7006 IL 2251-7006