Safety and Efficacy of Using Tranexamic Acid at the Beginning of Robotic-Assisted Radical Prostatectomy in a Double-Blind Prospective Randomized Pilot Study.

Michal Balík,Petr Hušek,Josef Košina,Filip Čečka,Miloš Broďák

doi:10.14712/18059694.2020.60

Michal Balík, Petr Hušek + Show 3 more

Open Access

https://doi.org/10.14712/18059694.2020.60

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Abstract

The prophylactic administration of tranexamic acid has been shown to be appropriate for procedures with a high risk of perioperative bleeding in cardiac surgery and orthopaedics. In urology the ambiguous results have been reported. Our goal was to evaluate the effect of tranexamic acid administration in robotic-assisted radical prostatectomy (RARP). A pilot, prospective, double-blind, randomized study was conducted to evaluate this effect. The study included 100 patients who received RARP in the period from April 2017 to January 2018. The patients were randomly assigned to study and control groups of 50 patients each. The median follow-up was 6 months. Lower haemoglobin level drop weighted for gram of operated prostate was observed in the study group when treating the dorsal vein complex (DVC) at the beginning of the procedure (p = 0.004 after 3 hours and p < 0.001 after 24 hours). There was no evidence of any serious side effect of tranexamic acid. We demonstrated the safety of tranexamic acid at RARP. In addition, we showed that administration of tranexamic acid at the beginning of RARP significantly reduces the decrease in haemoglobin after the procedure when treating the DVC at the beginning of the procedure.

Highlights

Prostate adenocarcinoma is the most common malignancy in men
Despite tremendous development in the technology and technique of robotic-assisted radical prostatectomy over more than 25 years, we still need to look for ways to improve oncological and functional outcomes [4,5,6,7,8]
body mass index (BMI) and specimen weight were compared by the Kolmogorov-Smirnov test (Table 1)

Summary

Introduction

Prostate adenocarcinoma is the most common malignancy in men. The incidence increases over time and with patient age. In patients with moderate- and low-risk prostate cancer and life expectancy more than 10 years, the method of choice is radical prostatectomy or radiotherapy [1,2,3]. In the treatment of localized prostate cancer, laparoscopic and robotic-assisted radical prostatectomy (RARP) have become the gold standard. Our goal was to evaluate the effect of tranexamic acid administration in robotic-assisted radical prostatectomy (RARP). Lower haemoglobin level drop weighted for gram of operated prostate was observed in the study group when treating the dorsal vein complex (DVC) at the beginning of the procedure (p = 0.004 after 3 hours and p < 0.001 after 24 hours). We showed that administration of tranexamic acid at the beginning of RARP significantly reduces the decrease in haemoglobin after the procedure when treating the DVC at the beginning of the procedure

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