Longo, M.A., Cavalheiro, B.T., & de Oliveira Filho, G.R. (2018). Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery. Journal of Clinical Anesthesia, 48, 32–38.

The purpose of the systematic review and meta-analysis was to identify if there is a difference between tranexamic acid (TXA) and a control group in blood loss, transfusion rates, hemoglobin levels, and thromboembolic events in prostate surgery patients.

• TYPE OF STUDY: Meta analysis and systematic review
• DATABASES USED: Medline, Cochrane Central Register of Controlled Trials, EBSCO, and Web of Science
• YEARS INCLUDED: 1976,1980, 2004, 2011, 2016, 2017
• INCLUSION CRITERIA: Randomized controlled trials comparing use of TXA with a control group
• EXCLUSION CRITERIA: None stated

• TOTAL REFERENCES RETRIEVED: 145
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Grading of Recommendations Assessment, Development, and Evaluation methodology was used for evaluation

• FINAL NUMBER STUDIES INCLUDED: 9 
• TOTAL PATIENTS INCLUDED IN REVIEW: 978 
• SAMPLE RANGE ACROSS STUDIES: 494 received TXA and 484 enrolled in the control group
• KEY SAMPLE CHARACTERISTICS: TXA was administered via IV in six of the studies, orally in two, and local spray in one.

PHASE OF CARE: Diagnostic

The results were reported on nine studies. Of the nine studies, six reported on the interoperative blood loss showing overall blood loss was lower in the TXA group (p < 0.000001). Transfusion rate was identified less in the TXA group (p < 0.00004) in six of the nine studies with the prostatectomy cases but not the TURP cases. Hemoglobin level was monitored 24 hours after surgery, but there was no noted significant difference between the TXA and the control groups in four of the studies. Eight studies monitored for DVT and PE, and no statistical difference was found.

This systemic review and meta-analyses concluded that patients who received TXA treatment during prostate surgery had a reduction in interoperative blood loss and decrease need for transfusion with no increased risk of DVT or PE.

• Limited number of studies included
• High heterogeneity

Although there was no increase in risk for DVT or PE using TXA, nurses should still be aware of the potential risk and monitor the patient with discretion.