Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach
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
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
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
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
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
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
The effects of lysine analogs during pelvic surgery: a systematic review and meta-analysis
Transfusion Medicine Reviews. 2014;28((3):):145-55.
Pelvic vasculature is complex and inconsistent while pelvic bones impede access to pelvic organs. These anatomical characteristics render pelvic surgery inherently difficult, and some of these procedures are frequently associated with blood loss that necessitates blood transfusion. The aim of this study was to review the literature on the use of lysine analogs to prevent bleeding and blood transfusion during pelvic surgery. The objective of this study was to assess the safety and efficacy of lysine analogs during pelvic surgery. A systematic literature search was performed using Medline, Cochrane Register of Clinical Trials, Embase, and the reference lists of relevant articles. Randomized controlled trials or observational cohort studies comparing a lysine analog to placebo or standard care were included. Outcomes collected were blood transfusion, blood loss, thromboembolic adverse events (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism), nonthromboembolic adverse events, and death. There were no language limitations. Fifty-six articles reported on 68 comparisons between a lysine analog and an inactive comparator, involving a total of 7244 patients published between 1961 and 2013. Thirty-nine studies evaluated urologic procedures, and 21 evaluated gynecologic procedures. Thirty-six studies (60%) were published before 1980. Of the 43 randomized comparisons, only 30 (44%) had a score of 3 or higher on Jadad's 5-point scale of methodological quality. Among randomized trials, lysine analogs reduced the risk of blood transfusion (pooled odds ratio [OR], 0.47; 95% confidence interval [CI], 0.35-0.64) and blood loss (pooled OR, 0.22; 95% CI, 0.18-0.27). There was a small statistically insignificant increased risk of thromboembolic events (pooled OR, 1.07; 95% CI, 0.72-1.59) and no-thrombotic serious adverse events (pooled OR, 1.11; 95% CI, 0.67-1.83). In the 17 randomized trials published since the year 2000, only 6 thrombotic events were reported, 4 of which occurred in the placebo arm. Lysine analogs did not increase risk of death (pooled OR, 0.91; 95% CI, 0.34-2.48). These results are significant as they indicate that lysine analogs significantly reduce blood loss and blood transfusion during pelvic surgery. Although there does not appear to be a large increase in the risk of thromboembolic and nonthrombotic adverse events, more data are required to definitively assess these outcomes. Based on this review, lysine analogs during pelvic surgery seem to reduce bleeding and blood transfusion requirements. Although there does not seem to be a significant risk of adverse effects, larger studies would help clarify risks, if any, associated with lysine analog use. Copyright © 2014 Elsevier Inc. All rights reserved.
Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: double blind, randomised, placebo controlled trial
BMJ (Clinical Research Ed.). 2011;343:d5701.
OBJECTIVES To determine the efficacy of intraoperative treatment with low dose tranexamic acid in reducing the rate of perioperative transfusions in patients undergoing radical retropubic prostatectomy. DESIGN Double blind, parallel group, randomised, placebo controlled trial. SETTING One university hospital in Milan, Italy. PARTICIPANTS 200 patients older than 18 years and undergoing radical retropubic prostatectomy agreed to participate in the trial. Exclusion criteria were atrial fibrillation, coronary artery disease treated with drug eluting stent, severe chronic renal failure, congenital or acquired thrombophilia, and known or suspected allergy to tranexamic acid. INTERVENTIONS Intravenous infusion of tranexamic acid or equivalent volume of placebo (saline) according to the following protocol: loading dose of 500 mg tranexamic acid 20 minutes before surgery followed by continuous infusion of tranexamic acid at 250 mg/h during surgery. MAIN OUTCOME MEASURES Primary outcome: number of patients receiving blood transfusions perioperatively. Secondary outcome: intraoperative blood loss. Six month follow-up to assess long term safety in terms of mortality and thromboembolic events. RESULTS All patients completed treatment and none was lost to follow-up. Patients transfused were 34 (34%) in the tranexamic acid group and 55 (55%) in the control group (absolute reduction in transfusion rate 21% (95% CI 7% to 34%); relative risk of receiving transfusions for patients treated with tranexamic acid 0.62 (0.45 to 0.85); number needed to treat 5 (3 to 14); P = 0.004). At follow-up, no patients died and the occurrence of thromboembolic events did not differ between the two groups. CONCLUSIONS Intraoperative treatment with low dose tranexamic acid is safe and effective in reducing the rate of perioperative blood transfusions in patients undergoing radical retropubic prostatectomy. Trial registration ClinicalTrials.gov identifier NCT00670345.
Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR -P)
Central European Journal of Urology. 2011;64((3)):156-8.
INTRODUCTION Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. We investigated the effect of TXA on the amount of blood loss during transurethral resection of the prostate (TURP). MATERIALS AND METHODS Forty patients with registry numbers ending in even numbers were allocated to the treatment group; those ending in odd numbers were used as controls and received no treatment. The treatment group received 10 mg/kg TXA by intravenous infusion during the first half hour of the operation, while the control group of patients received no medication. Serum hemoglobin was measured before and after surgery. The volume and hemoglobin concentration of the irrigation fluid, resected prostate weight, and duration of resection were recorded. RESULTS The mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the TXA group and 2.84 g in the control group. Total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given TXA than in the control group (p = 0.018 and p <0.001). CONCLUSION Reduced bleeding during TURP as a result of TXA treatment may lead to better surgical conditions and, as a consequence, shorter operative times and lower irrigating fluid volumes.
Tranexamic acid in control of primary hemorrhage during transurethral prostatectomy
OBJECTIVES To determine whether short-term treatment of patients about to undergo transurethral resection of the prostate (TURP) with tranexamic acid (TXA) would be beneficial in reducing the associated blood loss. METHODS A prospective and randomized trial was conducted with 136 men requiring TURP for obstructive urinary symptoms. The treatment group received 2 g TXA three times daily on the day of, and first day after, the operation. RESULTS Short-term TXA treatment significantly reduced the operative blood loss associated with TURP (128 mL versus 250 mL, P = 0. 018), and this difference was not a result of the amount of tissue resected between the two groups (16 g versus 16 g, P = 0. 415). In addition, TXA treatment reduced the amount of blood loss per gram of resected tissue (8 mL/g versus 13 mL/g, P = 0. 020). Furthermore, the volume of irrigating fluid required (15 L versus 18 L, P = 0. 004) and operating time (36 minutes versus 48 minutes, P = 0. 001) were also reduced. However, TXA treatment did not influence the number of patients requiring a blood transfusion. Six patients in the treatment group (7. 2%) and five in the control group (6. 8%) required a transfusion (P = 0. 709). Moreover, TXA treatment did not affect the duration of catheterization (1 day versus 1 day, P = 0. 342) or hospitalization (3 days versus 3 days, P = 0. 218). CONCLUSIONS Short-term TXA treatment is effective in reducing the operative blood loss associated with TURP.