Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 4:2025:9294177.
doi: 10.1155/aiu/9294177. eCollection 2025.

Effect of Intraoperative Local Administration of Tranexamic Acid on Hemorrhage in Patients Undergoing Open Prostatectomy: A Double-Blinded Randomized Parallel-Group Trial

Mahdi Hemmati Ghavshough  1 , Zahra Shirinzadeh  2 , Mansour Alizadeh  3 , Mohammad Sadri  3 , Saman Farshid  3
Affiliations

Effect of Intraoperative Local Administration of Tranexamic Acid on Hemorrhage in Patients Undergoing Open Prostatectomy: A Double-Blinded Randomized Parallel-Group Trial

Mahdi Hemmati Ghavshough et al. Adv Urol. .

Abstract

Background and Objective: Benign prostatic hyperplasia (BPH) often necessitates surgical treatment, with open prostatectomy remaining a standard approach. However, this procedure carries a significant risk of intraoperative and postoperative bleeding, often requiring blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown potential in reducing surgical blood loss. This study aims to evaluate the effect of intraoperative local administration of TXA on perioperative blood loss in patients undergoing open prostatectomy for BPH. Methods: In this double-blind randomized controlled trial, 140 patients with BPH were assigned to either a TXA group or control group. In the intervention group, 1 g of TXA was diluted in 100 mL of normal saline and injected into the prostatic fossa during surgery, followed by three additional postoperative doses. The primary outcome was total perioperative blood loss. Secondary outcomes included changes in hemoglobin, hematocrit, platelet count, transfusion requirement, and length of hospital stay. Baseline differences, including a significant age gap between the groups (mean age: TXA group 60.70 ± 7.44 years vs. control group 70.50 ± 6.68 years), were statistically adjusted during analysis. Results: Perioperative blood loss was significantly lower in the TXA group (116.65 ± 43.23 mL) compared to the control group (210.27 ± 87.94 mL, p value = 0.001). The mean hemoglobin drop was also significantly reduced in the TXA group at both 24 and 48 h postoperatively. Fewer patients in the TXA group required blood transfusion (2.85%) compared to the control group (10%, p value = 0.03). No major adverse events directly attributed to TXA were identified, although one patient in the TXA group developed a pulmonary embolism. Conclusion: Intraoperative local administration of TXA significantly reduces perioperative blood loss and the need for blood transfusion in patients undergoing open prostatectomy. TXA appears to be a safe and effective strategy for minimizing surgical bleeding in this setting. Trial Registration: Iranian Registry of Clinical Trials: IRCT20180625040232N8.

Keywords: hemorrhage; open prostatectomy; tranexamic acid.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flowchart diagram.
Figure 2
Figure 2
Hemoglobin changes in 24 and 48 h after intervention.
Figure 3
Figure 3
Hematocrit changes in 24 and 48 h after intervention.
Figure 4
Figure 4
Platelet changes in 24 and 48 h after intervention.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Meigs J. B., Mohr B., Barry M. J., Collins M. M., McKinlay J. B. Risk Factors for Clinical Benign Prostatic Hyperplasia in a Community-Based Population of Healthy Aging Men. Journal of Clinical Epidemiology . 2001;54(9):935–944. doi: 10.1016/s0895-4356(01)00351-1. - DOI - PubMed
    1. Hugosson J., Stranne J., Carlsson S. V. Radical Retropubic Prostatectomy: A Review of Outcomes and Side-Effects. Acta Oncologica . 2011;50(sup1):92–97. doi: 10.3109/0284186x.2010.535848. - DOI - PubMed
    1. Djavan B., Agalliu I., Laze J., Sadri H., Kazzazi A., Lepor H. Blood Loss During Radical Prostatectomy: Impact on Clinical, Oncological and Functional Outcomes and Complication Rates. BJU International . 2012;110(1):69–75. doi: 10.1111/j.1464-410x.2011.10812.x. - DOI - PubMed
    1. Kumsar S., Dirim A., Toksöz S., Sağlam H. S., Adsan O. Tranexamic Acid Decreases Blood Loss During Transurethral Resection of the Prostate (TUR-P) Central European Journal of Urology . 2011;64(3):156–158. doi: 10.5173/ceju.2011.03.art13. - DOI - PMC - PubMed
    1. Nielsen J. D., Gram J., Fabrin K., Holm‐Nielsen A., Jespersen J. Lack of Correlation Between Blood Fibrinolysis and the Immediate or Post‐Operative Blood Loss in Transurethral Resection of the Prostate. British Journal of Urology . 1997;80(1):105–110. doi: 10.1046/j.1464-410x.1997.00251.x. - DOI - PubMed

LinkOut - more resources