Introduction. Monopolar-TUR-P is the standard surgical procedure for men with prostate sizes of 30-80 ml. Perioperative macrohematuria is associated with an increase in fibrinolytic activity of urine. Tranexamic acid is a potent inhibitor of plasminogen. Objective. The purpose of this study is to determine the efficacy of tranexamic acid in the management of perioperative macrohematuria and the need for hemotransfusion. Material and methods. A retrospective pilot study performed at Urology department, during October - December 2022 included 65 patients aged 60-84 years. Patients were divided into two groups: 1) 33 patients in whom tranexamic acid was administered intravenously 1000mg during surgery and 500 mg intravenously every 8 hours postoperatively and 2) 32 - the control group. Results. The operating time in 1 group was with 12.7 min less than in 2 group (49.5 min vs 62.2 min). The decrease in serum hemoglobin level 24 hours after surgery was not significant (8.5 g/l vs 15.2 g/l). Hemotransfusion was required in 2 patients from the second group (6.25%). We identified a significant decrease in the time of postoperative macrohematuria (6.5 hours vs 22.1 hours). Conclusion. Intravenous administration of tranexamic acid in recommended doses decreases the risk of postoperative hemorrhagic complications, the need for hemotransfusions and significantly the duration of postoperative macrohematuria.