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Abstract

Purpose:

The purpose of this article is to evaluate and compare the effect of intravenous tranexamic acid (TXA) with placebo on haemorrhage and quality of vision during and post-transurethral resection of the prostate (TURP).

Methods:

For nine months (September 2016 until June 2017), a randomised clinical trial was conducted with 70 patients, age 50–80 years, who were included in the study according to inclusion criteria (patients who required surgical intervention because of benign prostatic hyperplasia, prostate weight (<100 cc), American Society of Anesthesiologists score ⩽II, etc.) and enrolled randomly one to one in two study groups, and who underwent TURP in Shahid Beheshti Hospital of Hamadan University of Medical Sciences by a single surgeon.

Interventions:

The study group participants received 500 mg TXA in 500 ml ringer serum (concentration of 1 mg/ml, infusion rate 100 mg/min, maximum dose of 15 mg/kg), whereas the control group received only ringer serum during surgery. The results were then compared for the variables operation time, amount of haematocrit (HCT)-haemoglobin (Hb) reduction following surgery and surgeon satisfaction.

Results:

Both groups had no difference in age, weight and prostate weight. Surgeon satisfaction was evaluated at the end of the operation. The frequency of high satisfaction in case and control groups was 74.3% and 8.65%, whereas low satisfaction was 0% and 42.69%, respectively (p < 0.05). The mean time of operation was 53.57±16.43 vs 120.71±47.76 minutes in the case and control group, respectively (p < 0.05). The mean HCT-Hb decrease (p = 0.00) and the amount of infused volume before and after the operation (p = 0.03) between both groups were significantly different. None of the patients experienced TXA side effects.

Conclusions:

Intravenous TXA can prevent haemorrhage and higher Hb and HCT reduction following TURP, shortening the operation time and improving surgeon vision during TURP.

Level of evidence:

Keywords

Haemorrhage placebo RCT tranexamic acid TURP

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References

Wein

Kavoussi

Patrin

, et al. Campbell-Walsh urology. 11th ed. Chapter 105. Philadelphia, PA: Elsevier, 2016, pp.2504–2534.

Miller

RD.

Miller’s anesthesia. Vol. 2. 7th ed. Philadelphia, PA: Churchhill Livingstone Elsevier, 2010, pp. v, xxii, 3084, 3089.

Foster

Barry

Gandhi

, et al. Benign prostatic hyperplasia: Surgical management of benign prostatic hyperplasia/lower urinary tract symptoms (2018, amended 2019), www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

Gravas

Bach

Bachmann

, et al. EAU guidelines on non-neurogenic male LUTS including benign prostatic obstruction (limited text update March 2016). European Association of Urology Pocket Guideline. European Association of Urology, 2016, pp.133–151.

Foo

KT.

Benign prostatic hyperplasia. In: Principles and practice of urology. 2nd ed. Bangladesh: Jaypee Brothers Medical Publishers, 2013, pp.584–595.

Kumsar

Dirim

Tiksöz

, et al. Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR-P). Cent European J Urol 2011; 64: 156–158.

Borboroglu

Kane

Ward

, et al. Immediate and postoperative complications of transurethral prostatectomy in the 1990s. J Urol 1999; 162: 1307–1310.

Nielsen

Gram

Fabrin

, et al. Lack of correlation between blood fibrinolysis and the immediate or post-operative blood loss in transurethral resection of the prostate. Br J Urol 1997; 80: 105–110.

Wellington

Wagstaff

AJ.

Tranexamic acid: A review of its use in the management of menorrhagia. Drugs 2003; 63: 1417–1433.

10.

Dunn

Goa

KL.

Tranexamic acid: A review of its use in surgery and other indications. Drugs 1999; 57: 1005–1032.

11.

Mannucci

PM.

Hemostatic drugs. N Engl J Med 1998; 339: 245–253.

12.

Mannucci

PM.

Treatment of von Willebrand’s disease. N Engl J Med 2004; 351: 683–694.

13.

Aroney

Dalley

Levi

JA.

Hemorrhagic cystitis treated with epsilon-aminocaproic acid. Med J Aust 1980; 2: 92.

14.

Brown

Thwaites

Mongan

PD.

Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass operations: A double-blind, randomized, placebo-controlled trial. Anesth Analg 1997; 85: 963–970.

15.

De Bonis

Cavaliere

Alessandrini

, et al. Topical use of tranexamic acid in coronary artery bypass operations: A double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg 2000; 119: 575–580.

16.

Krohn

Sørensen

Lange

, et al. Tranexamic acid given into the wound reduces postoperative blood loss by half in major orthopaedic surgery. Eur J Surg Suppl 2003; 588: 57–61.

17.

Wyngaarden

Smith

(eds) Cecil textbook of medicine. 18th ed. Philadelphia: WB Saunders, 1988, p.1950.

18.

Levi

Levy

Andersen

, et al. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med 2010; 363: 1791–800.

19.

Fergusson

Hébert

Mazer

, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358: 2319–2331.

20.

CRASH-2 Trial Collaborators, Shakur

Roberts

, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet 2010; 376: 23–32.

21.

Henry

Carless

Moxey

, et al. Anti-fibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011; CD001886.

22.

Rannikko

Pétas

Taari

Tranexamic acid in control of primary hemorrhage during transurethral prostatectomy. Urology 2004; 64: 955–958.

23.

Miller

May

Hendry

, et al. The prevention of secondary haemorrhage after prostatectomy: The value of antifibrinolytic therapy. Br J Urol 1980; 52: 26–28.

24.

Crescenti

Borghi

Bignami

, et al. Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: Double blind, randomised, placebo controlled trial. BMJ 2011; 343: d5701.

25.

Alimian

Mohseni

The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: A placebo-controlled clinical trial. J Clin Anesth 2011; 23: 611–615.

26.

Al’-Shukri

Goloshchapov

Lukichev

GB.

Application of fibrinolysis inhibitor Tranexam in transurethral resection of the prostate [article in Russian]. Urologiia 2011; 41–43.

27.

Shrestha

Prasopshanti

Matanhelia

, et al. Blood loss during and after transurethral resection of prostate: A prospective study. Kathmandu Univ Med J (KUMJ) 2008; 6: 329–334.

28.

Jendoubi

Malouch

Bouzouita

, et al. Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial [article in French]. Prog Urol 2017; 27: 1036–1042.

29.

Chung

ASJ

Woo

. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol 2018; 5: 22–27.

Safety and efficacy of intraoperative administration of intravenous tranexamic acid in transurethral resection of prostate: A double-blind,randomised,placebo-controlled trial