Tranexamic acid of no help in reducing bleeding complications related to HoLEP

Perioperative tranexamic acid treatment in patients undergoing holmium laser enucleation of the prostate (HoLEP) falls short of reducing the risk of a return to the operating room (RTOR) for bleeding, catheter reinsertion, or clotting complications, according to a study.

The study included 1,037 patients who received tranexamic acid during HoLEP. None of them had a history of stroke, transient ischaemic attack, or coronary stent placed within 18 months. The primary outcome variable was RTOR for bleeding, while secondary outcomes included catheter reinsertion, transfusion, and clotting complications.

A total of 214 patients had one or more complications. Specifically, 81 had a Clavien-Dindo Grade of 3a or higher, 114 needed catheter reinsertion, 36 had RTOR for bleeding, and 15 had a transfusion.

Multivariable models showed that tranexamic acid use was not associated with 30-day RTOR. RTOR was documented in 3.7 percent of patients who did not receive tranexamic acid and in 3.1 percent of those who did (adjusted odds ratio [aOR], 0.63, 95 percent confidence interval [CI], 0.28–1.38; p=0.25).

Transfusion rates were significantly lower among patients who received tranexamic acid than among those who did not receive the drug (0.5 percent vs 2.0 percent; aOR, 0.13, 95 percent CI, 0.03–0.69; p=0.016; corrected p=0.048).

Finally, tranexamic acid use showed no association with catheter reinsertion or clotting complications.