Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery

Prostate cancer and benign prostatic hyperplasia have an increased incidence with aging. The most effective treatments are radical prostatectomy and transurethral resection of the prostate. To reduce perioperative bleeding in these surgeries, an approach is the use of tranexamic acid (TXA). Studies show that TXA is effective in reducing the blood loss and the need for transfusion in cardiac, orthopedic, and gynecological surgeries. In prostate surgeries, its efficacy and safety have not been established yet.

To determine whether there are differences between TXA versus placebo in terms of intraoperative blood loss, transfusion requirements, hemoglobin levels and the incidence of thromboembolic events.

Systematic review with meta-analyses.

Anesthesia for prostate surgery.

We searched the Medline, Cochrane, EBSCO, and Web of Science databases up to 2017 for randomized controlled trials that compared TXA administration with a control group in patients who submitted to prostate surgery.

The primary outcomes were the intraoperative blood loss and transfusion rate. Data on hemoglobin levels and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were also collected.

Nine comparative studies were included in the meta-analyses. The estimated blood loss and transfusion rate were lower in patients receiving TXA, with a standardized mean difference of -1.93 (95% CI = -2.81 to -1.05, I² = 96%), and a risk ratio of 0.61 (95% CI = 0.47 to 0.80, I² = 0%), respectively. The hemoglobin levels and the incidence of DVT and PE did not differ between the groups.

TXA reduced intraoperative blood loss and the need for transfusion, without increasing the risk of DVT and PE in prostate surgeries. Due to the limited number of studies and the high heterogeneity of the results, more clinical trials with a large number of patients are necessary to confirm these findings.