The role of intraoperative tranexamic acid in transurethral resection of the prostate: a systematic review and meta-analysis of randomised-controlled trials.

PURPOSE: To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP).

METHODS

A systematic search of online databases was conducted to identify randomised-controlled trials (RCTs) which compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated with TXA (intervention) as compared to placebo/none (control). The efficacy of intraoperative TXA was evaluated through outcomes related to blood loss, rate of blood transfusion and operative time. The safety of TXA was evaluated through pooled analysis of both deep venous thrombosis and pulmonary emboli.

RESULTS

Nine RCTs met the inclusion criteria for this meta-analysis in which a total of 661 patients underwent TURP for BPH (331 TXA: 330 Control). There was significantly less intraoperative bleeding in the TXA group (MD -40.23 mL [95%CI -66.76 to -13.71], p = 0.003), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (MD -0.55 g/dL [95%CI -0.71 to -0.39], p < 0.00001). TXA was associated with a significantly shorter operative time (MD -9.77 min [95%CI -16.97 to -2.58], p = 0.008), with patients who received TXA exposed to a significantly reduced risk of blood transfusion (0.99% TXA vs. 7.69% Control, OR 0.16 [95%CI 0.03-0.93], p = 0.04). There was no statistically significant increase in risk of DVT in the TXA group, p = 0.46.

CONCLUSION

Intraoperative administration of TXA is safe and effective in reducing intraoperative blood loss, operative time and postoperative haemoglobin (Hb) drop with resultant decrease in blood transfusion requirements. This meta-analysis did not detect any significant increase in venous thrombosis or risk of pulmonary embolism incurred by TXA administration.