A Single Preoperative dose of Tranexamic Acid Reduces Blood Loss and Heterologous Blood Transfusion in Radical Retropubic Prostatectomy

Abstract number: P1375

Schött¹ U, Jacobsson² A, Ekström² B, Annerstedt¹ M

¹¹University of Lund, Lund, and County Hospital Halmstad, Halmstad, Sweden ¹¹University of Lund, Lund, and County Hospital Halmstad, Halmstad, Sweden ²²County Hospital Halmstad, Halmstad, Sweden

Tranexamic acid was used extensively in the 1970ies during open postatectomies, then initially with the new endoscopic techniques (Miller RA, Br J Urolog 1980), but was disfavoured by the majority depending on views of lack of effect, concerns of increased thromboembolism, worsening DIC in urologic cancer patients and increased risk for blood clots obstructing urine flow. The importance of administering tranexamic acid, before surgical incision for optimal hemostatic effect, was verified in cardiac surgery in several studies in the 1990ies. This was not highlighted in urology. A positive effect on bleeding of tranexamic acid in transurethetral prostatectomy has been verified recently (Ranniko et al, Urology 2004). Further on, in addition to changed surgical techniques for open prostatectomy also thromboprophylaxis has changed since the 1970ies. To determine whether tranexamic acid (TXA), in a single dose of 10 mg/kg bodyweight – administered intravenously (iv) as a 20 minutes infusion immediately before surgical skin incision would be beneficial in reducing intraoperative and postoperative drainage blood loss and transfusion need; 40 patients undergoing retropubic radical prostatectomy (prostatic cancer) were studied in a placebo-controlled, blinded and randomized way. Patients were operated by two senior surgeons. Patients received dalteparin 5000 U as thromboprophylaxis from the day before surgery and up to 10 days postoperatively. Tranexamic acid significantly (P < 0.01) reduced bleeding and transfusion need as compared to placebo (saline). With a boxplot analysis mean bleeding was 800 ml in the tranexamic-group and 1700 ml in the placebo-group. D-dimers were significantly (P < 0.01) lower in the tranexamic-group. No clinical thromboses were noted in any of the groups. In conclusion, a single dose of tranexamic acid, given iv immediately before skin incision reduced bleeding in radical retropubic prostatectomy.