Effectiveness of tranexamic acid for decreasing bleeding in prostate surgery: a systematic review and meta-analysis

Abstract

IntroductionThe objective of this study was to determine the effectiveness of tranexamic acid in decreasing bleeding in patients undergoing prostate surgery.Material and methodsAll clinical experiments were included without language restrictions. The inclusion criteria were as follows: men over 18 years of age who underwent prostate surgery (transurethral, prostate adenectomy, and radical prostatectomy) and received tranexamic acid prior to prostate surgery as a preventive measure for perioperative hemorrhage. Prophylactic tranexamic acid vs. no intervention or placebo were compared. The primary outcomes were as follows: 1) intraoperative blood loss and 2) the need for red blood cell transfusion. A systematic search was performed in MEDLINE, EMBASE, CENTRAL and LILACS. Other sources were used to discover published and unpublished literature sources. The statistical analysis was performed in Review Manager v.5.3.ResultsFour studies were included with a total of 436 patients. Three of the four studies had small sample sizes. There was a low risk of attrition bias and reporting bias. Unclear risk of selection bias, performance bias, or detection bias was presented. A mean difference (MD) of -174.49 [95% CI (-248.43 to -100.56)] was found for perioperative blood loss (the primary outcome). At the end of the procedure, the hemoglobin concentration had a MD of -1.19 [95% CI (-4.37 to 1.99)].ConclusionsTranexamic acid is effective at preventing perioperative blood loss compared with the placebo in patients undergoing transurethral resection of the prostate (TURP). However, this treatment was not effective neither at preventing the need for transfusions nor at increasing hemoglobin values at the end of the procedure.

[Retracted] Using Haemocoagulase Agkistrodon in Patients Undergoing Transurethral Plasmakinetic Resection of the Prostate: A Pilot, Real‐World, and Propensity Score‐Matched Study

“…In our study, HCA and TXA showed no significant differences in postoperative indicators of concern. A meta-analysis indicated that TXA effectively reduced perioperative blood loss compared with placebo in patients undergoing TURP; however, there was no significant improvement in preventing transfusions and increasing hemoglobin [ 32 ]. The hemostatic effects of EDD and TXA have been compared, and EDD was found to be more effective than TXA in reducing blood loss in open prostatectomy patients [ 11 ].…”

Incidence and Mortality Related to Gastrointestinal Bleeding, and the Effect of Tranexamic Acid on Gastrointestinal Bleeding

“…It is shown that TXA administration intravenously can reduce maternal mortality from post-partum hemorrhage without increasing the risk for thromboembolic events [ 12 ]. It is also used within elective orthopedic, gynecology and urologic surgery, decreasing perioperative bleeding and the need for transfusions [ 13 - 15 ]. In the CRASH-2 study, a big multicenter study involving 20,211 adult trauma patients with or at risk for significant bleeding, also showed TXA’s effectiveness in reducing mortality, if given early in the process, like other studies have shown [ 16 - 18 ].…”