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Effect of tranexamic acid on bleeding outcomes after percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials

Dalhousie University Faculty of Medicine, 12361, Urology, 1276 South Park St., Room 294, 5 Victoria, B3H 2Y9, Halifax, Nova Scotia, Canada, B3H 4R2; morgan.macdonald@dal.ca. Dalhousie University Faculty of Medicine, 12361, Urology, Halifax, Nova Scotia, Canada. Dalhousie University, 3688, Community Health and Epidemiology, Halifax, Nova Scotia, Canada. Dalhousie University, 3688, Radiation Oncology, Halifax, Nova Scotia, Canada. Dalhousie University, 3688, Psychology, Halifax, Nova Scotia, Canada; gabriela.ilie@dal.ca. Dalhousie University Faculty of Medicine, 12361, Halifax, Nova Scotia, Canada; liampower@dal.ca. Dalhousie University Faculty of Medicine, 12361, Urology, Halifax, Nova Scotia, Canada; stewart.whalen@dal.ca. Dalhousie University W K Kellogg Health Sciences Library, 491382, Halifax, Nova Scotia, Canada; robin.parker@dal.ca. Dalhousie University Faculty of Medicine, 12361, Urology, Halifax, Nova Scotia, Canada; tomaaskinner@gmail.com. Dalhousie University Faculty of Medicine, 12361, Urology, Halifax, Nova Scotia, Canada; andrea.lantz@dal.ca.

Journal of endourology. 2021
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Abstract
PURPOSE We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid during percutaneous nephrolithotomy. METHODS This systematic review was conducted following best practices from Cochrane and the Institute of Medicine [Cochrane Handbook and IOM citations]. We followed the updated reporting guidelines from PRISMA 2020. RESULTS In total 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data was extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [ 95% CI (0.19 to 0.61), z= 3.61, p=0.0003]. Mean Hemoglobin (Hgb) drop, and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was -0.86 [ 95% CI (-1.26 to -0.46), z= 4.23, p< 0.0001]. Reduction in operative time showed a mean difference of -8.45 min [ 95% CI (-15.04 to -1.86), z= 2.51, p= 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [ 95% CI (0.89 to 1.84), z= 1.31, p= 0.19]. CONCLUSIONS This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine