Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men

C. I. Onyeze, 1T. A. Badmus, 1A. A. Salako, 2A. M. Owojuyigbe, 3E. A. Jeje, 1O. O. Olasehinde, 1A. Adeyemo, 1,5R. A. David

Abstract

BACKGROUND: Haemorrhage is a common complication following
open simple prostatectomy and patients may sometimes require a
blood transfusion. Tranexamic acid has been shown to reduce blood
loss following transurethral resection of the prostate and open radical
prostatectomy. This study evaluated the effect of perioperative
intravenous administration of tranexamic acid on blood loss and blood
transfusion rates in patients who had OSP for benign prostatic
enlargement.

METHODOLOGY: This was a comparative study of patients with
documented prostate glands 60g and above scheduled for OSP. Initial
hematocrit was done a day before surgery. The patients were
randomized into a tranexamic acid group, which received perioperative
intravenous tranexamic acid and the no-TXA group which received
placebo (0.9% saline). All patients had open simple retropubic
prostatectomy. Final post-operative hematocrit was assessed 72 hours
after surgery, and blood loss was calculated using the modified Gross
formula (actual blood loss = estimated blood volume x change in
hematocrit / mean hematocrit). The transfusion rate was documented.

RESULTS: Fifty-six patients participated in this study and were
randomized into a tranexamic acid group and no-tranexamic acid group.
The mean age of patients in the tranexamic acid group was 66.07
±7.08 years and was comparable to the no- tranexamic acid group
which was 66.50 ± 8.80 years (P = 0.842). The median total blood
loss was lower in the tranexamic acid group (502mls, IQR 613)
compared to the no-tranexamic acid group (801mls, IQR 1069). The
difference in the median blood loss between the two groups was
299mls (U 275, P 0.055). The rate of blood transfusion was lower in
the tranexamic acid group (6 patients, 21%) compared to the notranexamic
acid group (11 patients, 39%), (P = 0.146). There was no
difference in complication rates between the two groups.

CONCLUSION: The use of tranexamic acid in patients undergoing
open simple prostatectomy showed a trend towards reduced intraoperative
blood loss and less need for blood transfusion. This is of
clinical significance, especially in elderly patients with low
cardiovascular reserve. WAJM 2023; 40(9): 909–913.

Keywords: Benign prostatic enlargement, Open simple
prostatectomy, Haemorrhage, Tranexamic acid.