Tranexamic Acid fails to increase incidence of same-day discharge among Holmium Laser Prostate Surgery patients

U.S.A.: The inclusion of Tranexamic Acid (TXA) did not increase the incidence of same-day discharge or decrease the risk of complications in patients receiving HoLEP, according to prospective randomized research published in the Journal of Endourology.

To stop bleeding during orthopedic surgeries, tranexamic acid (TXA), a clot-promoting drug, is used. TXA has advantages in percutaneous surgery, according to urologists. Surgery for benign prostatic hyperplasia might cause hematuria, which could delay discharge or need ER visits.

The outcomes of same-day holmium laser enucleation of the prostate (HoLEP) were examined, and the influence of the addition of a single dosage of tranexamic acid (TXA) was assessed in this study.

110 patients receiving HoLEP were prospectively randomized from September 2021 to January 2022 to receive either 1 gram of TXA following induction or no treatment at all. Rate of successful same-day (SDD) discharge was the primary result. The transfusion rate, same-day catheter removal, length of stay (LOS), and 90-day complications were considered secondary outcomes. 110 individuals should be enrolled, according to power analysis, to detect a 25% difference in the SDD rate.

Key highlights of the study:

• Between the control (n=55) and TXA (n=55) groups, there were no differences in the patient demographics or prostate characteristics (all p>0.05).
• Between the control and TXA groups, the overall success rate of SDD was the same (49/55 (89%) vs. 51/55 (93%), p=0.74).
• Only 3/110 (2.7%) of the participants had a LOS >24 hours, and the median LOS (hh:mm) did not differ across groups (03:07 vs. 02:50, p=0.23).
• 99/110 (90%) patients had successful same-day catheter removal, with no difference between groups (49/55 vs. 50/55, p=0.99).
• Operative parameters (time, energy, specimen weight), as well as postoperative complications (all p>0.05), did not differ between groups.
• No patients needed blood transfusions, and there were no significant postoperative sequelae within 90 days (Clavien-dindo IIIb).

Although safe, TXA treatment had little impact on same-day release after HoLEP, concluded the authors.

REFERENCE

Assmus MA, Lee MS, Helon JW, Krambeck A. Tranexamic Acid Does Not Improve Outcomes of Holmium Laser Enucleation of the Prostate (HoLEP): A Prospective Randomized, Controlled Trial. J Endourol. 2022 Oct 12. doi: 10.1089/end.2022.0407. Epub ahead of print. PMID: 36222618.