Efficacy of a short prophylaxis with tranexamic acid on hemostasis during transrectal prostate biopsy in patients taking oral anti-platelet treatment.

Purpose: To assess the efficacy of a short prophylaxis with tranexamic acid in reducing blood loss during transrectal ultrasound-guided prostate biopsy (TRUSBx) in patients taking oral anti-platelet therapy and to prospectively compare this approach with patients without oral prophylaxis.

Methods: A total of 359 consecutive patients taking chronic low dose aspirin were enrolled in this prospective study. Before TRUSBx all patients were randomly assigned into two groups; a short oral prophylaxis with tranexamic acid 500 mg orally, taken one hour before the procedure (group A, N:178 ) and those without oral prophylaxis (group B, N:181). Patients were asked about complications, their frequency, severity of bleeding (hematuria, hematospermia, rectal bleeding) on a 0-5 scale, with 0 representing absence of bleeding and 5 very severe bleeding.

Results: No significant differences were noted between the two groups in radiation to age, preoperative PSA level, prostate volume, biopsy numbers, and Gleason score. There were no severe bleeding complications (grade 5) recorded in both groups. The study revealed significant differences in the incidence of hematuria (p<0.001) and rectal bleeding (p<0.002) between the groups. Patients in group A (16.9%) experienced fewer hematuria and rectal bleeding episodes than did the group B patients (31.5%). The number of sexually active men still reporting hematospermia was 16.6% in group A and 19.4% in group B, with no statistical difference (p=0.32).

Conclusion: The continued use of anti-platelet agents in patient undergoing TRUSBx does not increase the incidence of mild bleeding complications, if these are associated with a short-term tranexamic acid treatment.