Intérêt de l’acide tranexamique dans les résections endoscopiques urologiques : étude prospective randomisée

Jendoubi, Ali; Malouch, A.; Bouzouita, A.; Riahi, Yosra; Necib, Hatem; Ghedira, S.; Houissa, Mohamed

doi:10.1016/j.purol.2017.09.008

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…The electronic database and manual search yielded a total of 782 studies published between 1976 and 2018. In total, 381 articles were considered for full-text review, of which 189 were excluded because of ineligible study designs (n = 55) or control groups (n = 92), ineligible end points (n = 27), missing or nontranslatable full text (n = 11), and duplicates (n = 4), leaving 192 RCTs for final analysis (Figure). Included studies were published in English, German, French, and Spanish.…”

Section: Resultsmentioning

confidence: 99%

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Section: Resultsmentioning

confidence: 99%

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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“…Similar results were also obtained by Pourfakhr et al 32 Several investigations have been conducted on transurethral resection of the prostate (TURP), but the results seem to be inconclusive. [33][34][35][36] In a systematic review and meta-analyses, Longo et al 37 Abbreviations: TXA, tranexamic acid; N/E, not evaluated; NS, not significant; S, significant.…”

Section: Urological Surgerymentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Zec¹,

Napoli²,

Fiévez³

et al. 2022

JMDH

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In cancer patients undergoing surgery, tumor biology and anticancer treatments can increase the risk of perioperative bleeding and blood transfusions. Notably, blood transfusions can be potentially associated with an increased risk of life-threatening immune responses, acute lung injury, postoperative infections, and thromboembolism. Moreover, the link between perioperative transfusion and increased risk of cancer recurrence cannot be excluded. On the other hand, cancer patients have an increased risk of thromboembolism due to cancer itself and antineoplastic systemic treatments including chemotherapy and anti-angiogenic drugs. In this complex scenario, effective and safe strategies aimed at the prevention of blood transfusions are warranted. This narrative review addresses the efficacy, and the safety of the synthetic antifibrinolytic agent tranexamic acid (TXA) when used perioperatively in cancer surgery. Although in not oncologic surgery the use of TXA has been extensively studied, in the setting of cancer patients requiring surgery, the evidence is scarce. An overview of the ongoing clinical research is also provided.

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“…The data of Jenboubi (2017) were separated into patients who underwent transurethral resection of the prostate and those who underwent transurethral resection of a bladder tumor. [11] In Mohammadi (2019), concerning percutaneous nephrolithotomy, the data were separated into patients with a stone size of >4 cm and those with a stone size of <4 cm. [14] Accordingly, for certain parameters (namely intraoperative blood loss, operative time, and decreased hemoglobulin levels at 24 hours after surgery), each of the data of a single study was recorded and analyzed as 2 separate data sources.…”

Section: Characteristics Of Enrolled Trialsmentioning

confidence: 99%

“…Additionally, only patients undergoing a single type of surgery were studied in each trial. [7][8][9][10][11][12][13][14][15][16][17][18][19] This limited evidence is not sufficiently strong to support the widespread use of TXA in patients undergoing urologic surgeries.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials

et al. 2023

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Background: This meta-analysis compared the effects of intravenous Tranexamic acid (TXA) and a placebo on hemostasis, hospital course, and complications in adult patients undergoing various urologic surgeries.Methods: The literature was extensively searched using various databases. The primary outcomes were standardized mean differences (SMDs) of intraoperative blood loss and odds ratios (ORs) of necessary blood product transfusion. The secondary outcomes included SMDs of operative time, SMDs of decreased hemoglobulin levels at 24 hours after surgery, and ORs of thromboembolic events.Results: The meta-analysis included 13 randomized controlled trials (RCT) comprising 1814 participants in total. The SMD of intraoperative blood loss for TXA versus placebo was −0.705 (95% confidence interval [CI]: −1.113 to −0.297). The pooled ORs of transfusion in the TXA group compared with the placebo group was 0.426 (95% CI: 0.290-0.625). These findings indicated a significantly lower intraoperative blood loss and a reduced need for transfusion following intravenous TXA. The pooled ORs of thromboembolic events in the TXA group compared with the placebo group was 0.664 (95% CI: 0.146-3.024).Conclusions: Intravenous TXA can reduce intraoperative blood loss, decrease the need for transfusion, and shorten operative time, and it does not increase the risk of thromboembolic events.

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Intérêt de l’acide tranexamique dans les résections endoscopiques urologiques : étude prospective randomisée

Cited by 13 publications

References 19 publications

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials

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