Intravenous Tranexamic Acid in Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan. Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan. Kyoto University Health Service, Kyoto, Japan. Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. Department of Pharmacy, Okinawa Prefectural Chubu Hospital, Uruma, Japan. Department of Pharmacy, Okinawa Prefectural Hokubu Hospital, Nago, Japan. Department of Management Science, Graduate School of Engineering, Tokyo University of Science, Tokyo, Japan. Department of Biostatistics, Tsukuba Clinical Research & Development Organization, University of Tsukuba, Tsukuba, Japan. Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.

Nephron. 2022;:1-8

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Abstract
BACKGROUND Tranexamic acid is frequently reported to reduce bleeding-related complications in major surgery and trauma. We aimed to investigate whether tranexamic acid reduced hematoma size after percutaneous kidney biopsy. METHODS We conducted a double-blind, parallel three-group, randomized placebo-controlled trial at a teaching hospital in Japan between January 2016 and July 2018. Adult patients with clinical indication for ultrasound-guided percutaneous biopsy of a native kidney were included. Participants were randomly assigned into three groups: high-dose tranexamic acid (1,000 mg in total), low-dose tranexamic acid (500 mg in total), or placebo (counterpart saline). Intervention drugs were intravenously administered twice, as a bolus just before the biopsy and as a continuous infusion initiated just after the biopsy. Primary outcome was post-biopsy perirenal hematoma size as measured by ultrasound on the morning after the biopsy. RESULTS We assessed 90 adult patients for study eligibility, of whom 56 were randomly allocated into the three groups: 20 for high-dose tranexamic acid, 19 for low-dose tranexamic acid, and 17 for placebo. The median size of perirenal hematoma was 200 mm2 (interquartile range, 21-650) in the high-dose tranexamic acid group, 52 mm2 (0-139) in the low-dose tranexamic acid group, and 0 mm2 (0-339) in the placebo group (p = 0.048 for high-dose tranexamic acid vs. placebo). CONCLUSION In this trial, the median size of post-kidney biopsy hematoma was unexpectedly larger in the high-dose tranexamic acid group than in the placebo group. Although our results do not support the routine use of tranexamic acid in percutaneous kidney biopsy at present, further studies are needed to confirm the results.
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Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine