Tranexamic Acid in Men Undergoing Transurethral Resection of Prostate: An Updated Systematic Review and Meta-Analysis

Prostatic tissue is richly vascularized by large venous sinuses that may rupture during transurethral resection of the prostate (TURP), which may lead to unwanted functional outcomes and intraoperative bleeding. However, tranexamic acid (TXA) may be a valid strategy to reduce bleeding complications. Thus, we aimed to analyze the efficacy and safety of TXA administration in patients undergoing TURP.

We systematically reviewed the Medline, Embase, CENTRAL, and clinical trials registry platforms from their inceptions through April 2025 for randomized and quasi-randomized controlled trials with patients undergoing TURP that compared TXA versus placebo or no treatment. A pairwise meta-analysis with random-effects was performed to estimate risk ratios (RR), mean differences (MD) and their 95% confidence intervals (CI).

A total of 13 studies (N = 1140) were included in our synthesis. We found that patients using TXA (mean: 1.20 g/dL) compared to control (mean: 1.79 g/dL) had less reduction in postoperative hemoglobin concentration (MD: -0.58 g/dL, CI -0.95-[-0.22]). Additionally, patients using TXA (mean: 162.3 mL) compared to control (mean: 231.1 mL) had fewer intraoperative blood loss (MD: -68.7 mL, CI -128.73-[-8.67]). We did not find differences between TXA and control when analyzing risk of blood transfusion (RR: 0.71, CI 0.46-1.10), length of stay (MD: -1.50, CI -6.91-3.92), operative time (MD: -9.34, CI -19.40-0.72), or risk of thromboembolic events (RR: 1.15, CI 0.89-1.49). There were, however, differences in intervention protocols and the number of participants in each study, in addition to high heterogeneity in some endpoints.

TXA is associated with lower intraoperative blood loss and higher postoperative hemoglobin concentrations without increasing the risk of thromboembolic events, indicating a valid prophylaxis before TURP. However, further studies should better address the blood transfusion risk and be adequately powered for that purpose.