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5th April 2023
Administration of intra-vesical tranexamic acid to a Foley catheter in patients with gross haematuria, prior to continuous bladder irrigation, reduced both the length of stay in the emergency department (ED) and the duration of catheter placement, according to a before and after study by Korean researchers.
Macroscopic or gross haematuria is a commonly seen condition in the ED and for which there are a variety of causes. In gross haematuria, it is necessary to ensure that patients are not in urinary retention due to clot formation and in cases of clot retention, a three-way Foley catheter is used, to allow irrigation fluid to be passed through the bladder, clearing clots from the site of bleeding. Tranexamic acid has haemostatic effects and hinders fibrinolysis and clot degradation and while the drug has been used to control bleeding in conditions such as epistaxis, whether it can affect spontaneous bleeding from the lower urinary tract is less clear. However, to date, one small study in which bladder irrigation, local intra-vesical tranexamic acid and placebo were injected into the bladder via Foley catheter, found that the drug could significantly reduce the volume of required serum for bladder irrigation to clear urine.
Based on these encouraging preliminary findings, in the current study, the Korean team hypothesised that the use of tranexamic acid in those with gross haematuria, would reduce the duration of patient’s stay in the ED as well as the length of time for which Foley catheter placement was required. They conducted a ‘before’ and ‘after’ retrospective single-centre study, and examined the impact of using tranexamic acid in patients after a certain cut-off date (March 2022) and compared outcomes for patients before the specified date, i.e., those for whom tranexamic acid had not been used. The team set the primary outcomes as the length of stay in the ED and the duration of Foley catheter placement. The secondary outcomes were the admissions and the revisits for continuous bladder irrigation within 48 h after discharge.
Intra-vesical tranexamic acid and duration of ED stay
A total 159 patients with a mean age of 79.4 years (93.5% male) were included, with 86 in the ‘after’ group.
The results showed that the median length of stay in the ED was significantly shorter in the ‘after’ group (274 vs 411 minutes, p < 0.001). In addition, the median duration of the Foley catheter placement was also shorter (145 vs 308 minutes, p < 0.001).
There were also a lower proportion of ED visits among those given tranexamic acid (2.3% vs 12.3%, p = 0.031) as well as a trend towards less hospital admissions (29.1% vs 45.2%, p = 0.052).
The authors concluded that a reduction in length of stay of gross haematuria patients was observed after the implementation of intra-vesical tranexamic acid injection via a Foley catheter and called for further studies to confirm these findings.
Choi H et al. Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study. Am J Emerg Med 2023