Impact of Tranexamic acid in reducing intra-operative blood loss during mono-polar TURP in geriatric population: a comparative study from Pakistan – a state highly prevalent of anemia

BACKGROUND: In resource-limited countries, baseline anemia is highly prevalent among elderly patients. Elderly seeking surgical intervention for prostatic enlargement (PE) often find themselves in a clinical paradox: too unfit to endure surgery without risk yet too symptomatic to maintain an acceptable quality of life without intervention as surgery increases their vulnerability to the sequential surgical blood loss. Transurethral Resection of the Prostate (TURP) remains the gold-standard surgical treatment for PE. Intra-operative hemorrhage is its most common and significant complication. Tranexamic acid (TXA) is an antifibrinolytic agent proven to reduce bleeding in trauma. Studies exhibit improved intra-operative outcomes including decreased blood loss, reduced irrigation fluid and shorter operative times. METHODOLOGY: Conducted in Allied Hospital Faisalabad, 60 patients fulfilling inclusion criteria were enrolled. Two groups were made: Group-A received a single 1 g dose of TXA before induction of anesthesia while Group-B did not. Each group was further stratified by prostate weight: Subgroups A1/B1 (40-60 g) and A2/B2 (61-80 g). All patients underwent TURP and intra-operative blood loss was quantified using hemoglobin content in irrigation fluid with blood loss calculated via a standard equation. Resection time and resected tissue weight was recorded. RESULTS: Mean prostate weight of 62 ± 10.7 g in Group-A patients and 62.5 ± 10.8 g in Group-B patients. Blood loss in TURP was 289 ± 76 ml in Group-A versus 357 ± 81 ml in Group-B. Blood loss per gram of resected tissue was 11.4 ± 1.3 ml/g in Group-A and 14 ± 2.8 ml/g in Group-B. Segregated group result shows that TXA significantly reduced blood loss and blood loss per gram specifically in the case of large prostate as compared to small ones. CONCLUSION: In our quasi-experimental trial, pre-operative single dose administration of TXA in patients undergoing monopolar TURP brings out satisfactory results. TXA significantly reduces the intra-operative blood loss and blood loss per gram along with reduction in volume of irrigating fluid and duration of surgery. The classified group results reveal that TXA acts approximately equal on large and small prostates.