From the Guidelines
Tranexamic acid (TXA) is not recommended as a first-line treatment for bladder hematuria, as the current evidence is primarily focused on its use in trauma patients with significant bleeding. However, in certain cases where bleeding is severe or refractory to other treatments, TXA may be considered as an adjunctive therapy. The dosing regimen for TXA in the context of trauma, as recommended by the European guideline 1, is a loading dose of 1 g infused over 10 min, followed by an i.v. infusion of 1 g over 8 h. It is essential to note that the use of TXA in bladder hematuria is not well-established, and its efficacy and safety in this specific context are not clearly defined. The primary concern with using TXA in non-trauma settings is the potential increased risk of thromboembolic events, particularly in patients with a history of such disorders. Therefore, if TXA is to be used in the management of bladder hematuria, it should be done with caution and under close monitoring for potential side effects, including nausea, vomiting, diarrhea, and thromboembolic events. The most recent and highest quality study on TXA, although focused on trauma patients 1, emphasizes the importance of early administration of TXA in bleeding patients, which may have implications for its potential use in other bleeding conditions, including severe cases of bladder hematuria. In clinical practice, the decision to use TXA for bladder hematuria should be made on a case-by-case basis, considering the severity of bleeding, the underlying cause of hematuria, and the patient's risk factors for thromboembolic events. Given the lack of direct evidence supporting the use of TXA for bladder hematuria, further research is needed to establish its efficacy and safety in this context. Until then, TXA should not be considered a standard treatment for bladder hematuria but rather a potential adjunctive therapy in select cases where benefits may outweigh the risks, as guided by the principles of managing significant bleeding 1.
From the Research
Efficacy of Tranexamic Acid in Treating Bladder Hematuria
- Tranexamic acid has been shown to be effective in treating gross hematuria in patients with autosomal dominant polycystic kidney disease (ADPKD) 2.
- A pilot randomized clinical trial study found that local tranexamic acid significantly decreased the volume of serum used for bladder irrigation and reduced microscopic hematuria in patients with painless lower urinary tract bleeding 3.
- Tranexamic acid has also been used to treat life-threatening hematuria in polycystic kidney disease, with one case study showing that the hematuria stopped within 24 hours of treatment and did not recur after therapy ended 4.
- Additionally, a randomized clinical trial found that tranexamic acid decreased bleeding during percutaneous nephrolithotomy (PCNL) and reduced the need for blood transfusion 5.
Safety Considerations
- Chronic renal impairment is considered a relative contraindication to the use of tranexamic acid due to reports of ureteric clots and acute renal failure from cortical necrosis 4.
- Microscopic hematuria has been reported as a relative contraindication for tranexamic acid, as it can cause problems of clot formation in the urinary tract 6.
- However, some studies have shown that tranexamic acid can be used safely in patients with chronic kidney disease and polycystic kidney disease to treat severe hematuria 2, 4.