Related Experiment Videos
Perioperative tranexamic acid and postoperative haematuria after transvesical prostatectomy: a prospective
Branka Terzić1, Bogomir Milojević2,3, Marko Živković2
1Center for Anesthesiology and Reanimation, University Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia. terzic.branka@gmail.com.
Background:
Bleeding and postoperative haematuria remain clinically relevant after open simple prostatectomy. Tranexamic acid (TXA) may reduce bleeding through antifibrinolytic activity, but evidence in open prostate surgery for benign prostatic obstruction is limited. This study evaluated perioperative bleeding-related outcomes and observed thromboembolic events associated with TXA exposure in patients undergoing transvesical prostatectomy.
Methods:
This prospective, non-randomised, comparative cohort study included 72 patients undergoing transvesical prostatectomy between August 2020 and December 2021. Thirty-one patients received perioperative intravenous TXA and 41 were managed without TXA. Outcomes included intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, blood product transfusion, postoperative haematuria requiring continued or re-initiated bladder irrigation, and clinically apparent thromboembolic events within 30 days. Logistic regression and quantile median regression were used for exploratory adjusted analyses.
Results:
TXA exposure was not associated with statistically significant reductions in intraoperative blood loss, postoperative drain output, quantified perioperative blood loss, or blood product transfusion. Postoperative haematuria grade ≥ 1 occurred less frequently in the TXA group than in controls in unadjusted analysis (38.7% vs. 63.4%; p = 0.038). However, this association was attenuated and was no longer statistically significant after adjustment for prostate specimen weight, operative time, pre-existing urinary catheter status, and 5-alpha-reductase inhibitor therapy (adjusted OR 0.482, 95% CI 0.163-1.420; p = 0.186). Longer operative time remained associated with postoperative haematuria (adjusted OR 1.030 per minute, 95% CI 1.006-1.054; p = 0.013). Prostate specimen weight remained associated with blood product transfusion after adjustment. No clinically apparent thromboembolic events were recorded during hospitalisation or within 30 days postoperatively.
Conclusions:
TXA exposure was associated with lower observed postoperative haematuria in unadjusted analysis, but this association did not persist after adjustment. TXA was not associated with significant reductions in quantified perioperative blood loss or blood product transfusion. These findings are exploratory and require confirmation in adequately powered randomised studies.
