Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach

Gupta, Abhimanyu; Priyadarshi, Shivam; Vyas, Nitya; Sharma, Govind

doi:10.4103/ua.ua_41_20

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…Several small, randomised studies found that TXA use was associated with decreased intra-operative blood loss in patients undergoing transurethral resection of the prostate 657–660 . Local administration of TXA after prostate removal significantly reduced bleeding after prostatectomy surgery 661 .…”

Section: Discussionmentioning

confidence: 99%

“…656 Several small, randomised studies found that TXA use was associated with decreased intra-operative blood loss in patients undergoing transurethral resection of the prostate. [657][658][659][660] Local administration of TXA after prostate removal significantly reduced bleeding after prostatectomy surgery. 661 According to two systematic reviews with meta-analyses, TXA reduced intra-operative blood loss, without increasing the risk of DVT and pulmonary embolism in prostate surgery.…”

Section: Prothrombin Complex Concentratementioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

108

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: Prothrombin Complex Concentratementioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

108

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“…The use of tranexamic acid (TXA) to minimize blood loss in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is well accepted 18 . It is commonly used as a potent and reliable drug for decreasing bleeding and transfusion rates in cardiac, orthopedic, gynecological, transplant surgeries, and urological procedures, especially TURP 19 . A few authors asserted that TXA has a dose-dependent effect when administered during B-TURP and found that high-dose TXA significantly reduced the drop-in hemoglobin and ultimately needed for blood transfusions compared to placebo.…”

Section: Discussionmentioning

confidence: 99%

Intra-Prostatic Injection of Epinephrine during Transurethral Resection of Prostate Reduces Blood Loss and Need for Blood Transfusions

Zohaib¹,

Siddiq²,

Khalid³

et al. 2023

PJMHS

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Aim: To assess the role of Intraprostatic injection of epinephrine intra-operatively in patients undergoing TURP in decreasing blood loss and the need for subsequent blood transfusions. Design: A double-blind, randomized controlled trial. Place and duration of study: The Kidney Centre Postgraduate Training Institute, Karachi, from March till August 2020. Methodology: A total of 40 patients were chosen at random and divided into two groups of equal size. One group got an intra-prostatic injection of epinephrine, whereas the other received a standard saline injection. Both groups were evaluated in terms of prostate volume (ml), resected tissue (gms), surgical resection time (minutes), pre and post-operative Hemoglobin (HB), and Hematocrit (HCT) levels. Intra-operative blood loss was then quantified using the last two variables. Transfusion requirement in both groups was also recorded. Results: Mean +Age of patients in Group A and Group B was 66.30+9.24years and 65.65+7.43years, respectively, with no significant difference between both groups (p=0.808). Median and IQR Prostatic volume in Group A and Group B was 68.0, 15, and 64.0,21, suggesting no statistically significant difference between the two groups (p=0.372). Mean + S.D Loss of HB of patients in Group A and Group B was 1.15 + 0.42 and 1.87+1.04, respectively, with a significant difference between both groups (p=0.007). Mean + S.D of post-op HCT patients in Group A and Group B was 3.16+1.50 and 4.81+2.79, revealing a significant difference between the two groups (p=0.026). No patients in Group A needed blood transfusions, whereas six patients in Group B had blood transfusions, indicating a statistical distinction between the two groups (p=0.001). Conclusion: The use of intra-prostatic injection of epinephrine leads to reduced blood loss and subsequently reduced operative time, irrigation fluid usage, and blood transfusion during TURP. It also allows a greater amount of prostatic tissue to be resected. Keywords: Transurethral resection of Prostate, Epinephrine, Blood transfusion, Hemoglobin, Hematocrit.

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“…Sin embargo, los resultados secundarios tales como tiempo operatorio, el volumen de irrigación vesical, caída en el nivel de hemoglobina y los efectos adversos no fueron estadísticamente significativos a pesar de que hubo una disminución en dichos parámetros. 10 Hacen falta estudios con tamaños de muestra más grandes que puedan replicarse a gran escala. Tampoco existen recomendaciones en las principales guías de práctica clínica en urología al respecto.…”

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Topical Application of Tranexamic Acid in Urology: An Alternative Management?

Chávez

Delgado

Vargas

2022

Revista Urología Colombiana / Colombian Urology Journal

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Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach

Cited by 10 publications

References 20 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Intra-Prostatic Injection of Epinephrine during Transurethral Resection of Prostate Reduces Blood Loss and Need for Blood Transfusions

Topical Application of Tranexamic Acid in Urology: An Alternative Management?

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