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Tranexamic Acid in Men Undergoing Transurethral Resection of Prostate: An Updated Systematic Review and
Alessandro V Oliveira1,2, Ana Luiza N Sampaio1,2, Glicia A Freitas1
1Department of Medicine, University of Pará State, Belém, Pará, Brazil.
The Prostate
|November 5, 2025
Summary
Tranexamic acid (TXA) reduces bleeding during transurethral resection of the prostate (TURP) by lowering intraoperative blood loss and maintaining hemoglobin levels. This study found TXA to be a safe and effective prophylactic measure before TURP.
Area of Science:
- Urology
- Anesthesiology
- Pharmacology
Background:
- Transurethral resection of the prostate (TURP) carries risks of significant intraoperative bleeding due to the prostate's rich vascularization.
- Tranexamic acid (TXA) is a potential antifibrinolytic agent that may mitigate bleeding complications during surgical procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of tranexamic acid (TXA) administration in patients undergoing transurethral resection of the prostate (TURP).
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials were conducted.
- Databases searched included Medline, Embase, CENTRAL, and clinical trials registries up to April 2025.
- Pairwise meta-analysis using random-effects models estimated risk ratios and mean differences.
Main Results:
- Thirteen studies with 1140 patients were analyzed.
- TXA use was associated with significantly less reduction in postoperative hemoglobin (MD: -0.58 g/dL) and lower intraoperative blood loss (MD: -68.7 mL) compared to control.
- No significant differences were observed in blood transfusion risk, length of stay, operative time, or thromboembolic events.
Conclusions:
- Tranexamic acid (TXA) is an effective prophylaxis for transurethral resection of the prostate (TURP), reducing intraoperative blood loss and improving postoperative hemoglobin levels.
- TXA does not appear to increase the risk of thromboembolic events.
- Further adequately powered studies are needed to clarify the impact of TXA on blood transfusion requirements.
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