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Intraoperative tranexamic acid reduces blood loss and transfusion risk in TURP for benign prostatic hyperplasiaTranexamic acid reduces blood loss during prostate surgery

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Key Takeaway
Consider intraoperative tranexamic acid to reduce blood loss and transfusion risk in patients undergoing TURP for BPH.

This meta-analysis evaluated the impact of intraoperative tranexamic acid (TXA) on clinical outcomes for patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). The analysis included a total of 661 patients to assess efficacy and safety markers.

Key findings indicate that TXA significantly reduced intraoperative bleeding (MD -40.23 mL; 95%CI -66.76 to -13.71, p=0.003) and significantly shortened operative time (MD -9.77 min; 95%CI -16.97 to -2.58, p=0.008). Furthermore, patients receiving TXA experienced a significantly lesser hemoglobin drop on the first postoperative day (MD -0.55 g/dL; 95%CI -0.71 to -0.39, p<0.00001) and a significantly reduced risk of blood transfusion (OR 0.16; 0.99% TXA vs. 7.69% Control; 95%CI 0.03-0.93, p=0.04).

Regarding safety, the meta-analysis reported no statistically significant increase in the risk of deep venous thrombosis (p=0.46). The authors conclude that intraoperative TXA is safe and effective for reducing blood loss and transfusion requirements in BPH patients undergoing TURP. These results suggest TXA may be a viable clinical option for perioperative management in this population.

How this fits prior evidence

This meta-analysis addresses a gap in the management of surgical complications for benign prostatic hyperplasia (BPH). While previous coverage noted that UroLume endoprosthesis is associated with high restenosis and explantation rates in patients with BPH, this finding provides evidence for a pharmacological intervention to manage intraoperative bleeding during TURP. The results confirm that TXA is an effective and safe method to reduce blood loss and transfusion requirements without increasing the risk of deep venous thrombosis (p=0.46).

Men with an enlarged prostate often require a procedure called a TURP to relieve symptoms. During this surgery, managing blood loss is a major concern for both the patient and the surgical team. A review of data from 661 patients found that using a medication called tranexamic acid (TXA) during the operation significantly reduced the amount of blood lost during the procedure.

In addition to less bleeding, the study showed that patients who received TXA had a much lower drop in hemoglobin levels the day after surgery. The procedure was also completed about 10 minutes faster on average. Most importantly, the risk of needing a blood transfusion dropped from about 7.7% in the control group to less than 1% for those who received the medication.

Safety is a key factor in any treatment. The analysis found no significant increase in risks like deep vein thrombosis or pulmonary embolisms for patients receiving the medication. While the results are promising for making the surgery safer and more efficient, you should always talk to your doctor about specific treatment plans for your health.

What this means for you:
Tranexamic acid can reduce blood loss and the need for transfusions during prostate surgery.

Common questions

Does tranexamic acid make the surgery safer?

The study found that using tranexamic acid during surgery significantly reduced blood loss and the need for blood transfusions. It also did not show a statistically significant increase in risks like deep vein thrombosis or pulmonary embolisms. You should discuss these specific safety results with your surgeon.

How does it affect the time spent in surgery?

Patients who received tranexamic acid during their procedure had significantly shorter operative times, with a reduction of about 9.77 minutes on average compared to those who did not receive it.

Does it help with recovery after the procedure?

The data showed that patients who received the medication had a significantly lesser drop in hemoglobin levels on the first day after surgery. This helps maintain stable blood levels during the initial recovery period.

Study Details

Study typeMeta analysis
Sample sizen = 661
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
PURPOSE: To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP). METHODS: A systematic search of online databases was conducted to identify randomised-controlled trials (RCTs) which compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated with TXA (intervention) as compared to placebo/none (control). The efficacy of intraoperative TXA was evaluated through outcomes related to blood loss, rate of blood transfusion and operative time. The safety of TXA was evaluated through pooled analysis of both deep venous thrombosis and pulmonary emboli. RESULTS: Nine RCTs met the inclusion criteria for this meta-analysis in which a total of 661 patients underwent TURP for BPH (331 TXA: 330 Control). There was significantly less intraoperative bleeding in the TXA group (MD -40.23 mL [95%CI -66.76 to -13.71], p = 0.003), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (MD -0.55 g/dL [95%CI -0.71 to -0.39], p < 0.00001). TXA was associated with a significantly shorter operative time (MD -9.77 min [95%CI -16.97 to -2.58], p = 0.008), with patients who received TXA exposed to a significantly reduced risk of blood transfusion (0.99% TXA vs. 7.69% Control, OR 0.16 [95%CI 0.03-0.93], p = 0.04). There was no statistically significant increase in risk of DVT in the TXA group, p = 0.46. CONCLUSION: Intraoperative administration of TXA is safe and effective in reducing intraoperative blood loss, operative time and postoperative haemoglobin (Hb) drop with resultant decrease in blood transfusion requirements. This meta-analysis did not detect any significant increase in venous thrombosis or risk of pulmonary embolism incurred by TXA administration.
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