Tranexamic Acid for the Management of Hematuria: A Systematic Review

To evaluate tranexamic acid (TXA)'s efficacy in managing hematuria and synthesize current evidence to guide urological practice.

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyse 2020 guidelines and was registered in PROSPERO (CRD42022335404). We searched four databases, including PubMed, EMBASE, CINAHL, and Cochrane, for studies on TXA use in adults with hematuria with either interventional or observational designs. Data extraction and quality assessment were performed independently by 2 reviewers, and findings were summarized using a narrative synthesis.

The search yielded 227 records, of which seven studies (970 participants) met inclusion criteria. Four trials on postoperative hematuria showed that TXA-particularly intravenous-consistently reduced hemoglobin decline and blood loss. Three studies on non-postoperative hematuria demonstrated reductions in visible hematuria and symptom duration, though effects on transfusion and laboratory outcomes were variable. All administration routes-intravenous, oral, and intravesical irrigation-were effective; however, IV TXA showed superior outcomes in postoperative cases, while oral and irrigation routes appeared more advantageous in non-surgical settings.

TXA is effective in reducing both postoperative and non-postoperative hematuria, supporting its expanded use in urological practice. However, larger, high-quality studies are needed to confirm these findings and refine treatment protocols.