The following is a summary of “Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study,” published in the June 2023 issue of Emergency Medicine by Choi, et al.

Local tranexamic acid (TXA) applications have shown effectiveness in managing various hemorrhagic conditions. In cases of gross hematuria, continuous bladder irrigation (CBI) is the main treatment approach used in the emergency department (ED). However, CBI lacked pharmacological effects beyond blood clot removal through dilution. For a study, researchers sought to evaluate the impact of intravesical TXA injection before CBI in hematuria patients.

The retrospective, single-center study followed a before-and-after design. The study population consisted of hematuria patients who underwent CBI via a 3-way Foley catheter. The intervention involved injecting 1,000 mg of TXA through the Foley catheter, followed by CBI initiation after 15 minutes. Patients treated from March 2022 to August 2022 were assigned to the after group (intervention group), while those treated from March 2021 to August 2021 were assigned to the before group. Primary outcomes included the length of stay in the ED and the duration of Foley catheter placement. Secondary outcomes included admissions and revisits for CBI within 48 hours after discharge.

The before group consisted of 73 patients, while the after group had 86 patients. The intervention group showed a shorter median length of stay in the ED compared to the group not treated with TXA (274 mins vs. 411 mins, P < 0.001). Similarly, the intervention group had a shorter median duration of Foley catheter placement compared to the group not treated with TXA (145 mins vs. 308 mins, P < 0.001). Revisits after ED discharge were lower in the after group than in the before group (2.3% vs. 12.3%, P = 0.031). There was a trend for lower admissions in the TXA treatment group compared to the before group (29.1% vs. 45.2%, P = 0.052).

The intravesical TXA intervention led to reduced ED stay, shorter Foley catheter placement duration, and fewer revisits after ED discharge in hematuria patients.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001353