Is There Any Clinical Benefit for Peri-operative Administration of Tranexamic Acid for Patients Undergoing Percutaneous Nephrolithotomy? A Systematic Review and Meta-analysis

Abstract

Purpose of ReviewThe purpose of current systematic review and meta-analysis is to determine the efficacy and safety of the administration of tranexamic acid in patients undergoing PCNL. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. This systematic review and meta-analysis includes randomized comparative prospective studies. Recent Findings The primary endpoints were the hemoglobin drop, the bleeding complications, and the transfusion rate. Secondary endpoints included the operative time, the stone-free rate, the hospital stay, and the overall complications. Two-thousand five-hundred six publications were screened for this study. Six RCTs (1262 patients) were included in the metaanalysis. As for our primary endpoints, the hemoglobin drop was lower in the tranexamic group than in the control group, with mean difference (MD) of − 0.65 (p < 0.0001); the bleeding complications were rarer in the tranexamic group than in the control group, with an odds ratio (OR) of 0.32 (p < 0.00001); and the transfusion rate was lower in the tranexamic group with an OR of 0.34 (p = 0.0007). Concerning the secondary endpoints, the operative time was less in the tranexamic group with an MD of − 10.39 (p < 0.0001), the meta-analysis of the stone-free status data showed no statistical significance between the two groups with an OR of 1.58 (p = 0.09), the hospital stay was significantly less in the tranexamic group with an MD of − 1.38 (p = 0.005), and the overall complications were rarer in the tranexamic group than in the control group with an OR of 0.34 (p = 0.12). Summary The peri-operative use of TA contributes to the reduction of blood loss, bleeding complications, mean operative time, and hospital stay. The use of TA seemed to be safe and well tolerated in patients undergoing PCNL. PROSPERO protocol (Registration number: CRD42019122818)

Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review

“…Several systematic reviews [22,24,[47][48][49][50][51] have focused on the use of TXA in the PCNL setting, but most have serious methodological limitations and none to date has rated the CoE on a per-outcome basis. Multiple reviews [47][48][49][50][51] found TXA may reduce hospital length of stay GRADE Working Group grades of evidence: 'High certainty': we are very confident that the true effect lies close to that of the estimate of the effect. 'Moderate certainty': we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.…”

“…Two reviews [22,50] use the outdated Jadad system for addressing study quality. Three of these studies utilised a registered protocol [47,48,51] whereas the others did not. Importantly, TEE were not considered as an outcome of interest in three reviews [49][50][51].…”

“…Three of these studies utilised a registered protocol [47,48,51] whereas the others did not. Importantly, TEE were not considered as an outcome of interest in three reviews [49][50][51]. There was a significant amount of overlap in the studies included in this review and those previously done.…”

“…Several systematic reviews [22,24,47–51] have focused on the use of TXA in the PCNL setting, but most have serious methodological limitations and none to date has rated the CoE on a per‐outcome basis. Multiple reviews [47–51] found TXA during PCNL beneficial for patient outcomes including reduced blood transfusion, improved SFR, and reduced operative time, and reduced complication rates. None of these reviews utilised a formalised approach to rating CoE.…”

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

“…Another feared complication of PCNL is bleeding, regardless of tract size, with the CROES study reporting an overall bleeding risk of 7.8% [12]. Tranexamic acid has gained immense popularity of the 2 years with multiple studies showing a decrease in bleeding and increase in stone-free rate [13–16,17 ▪▪ ,18]. Batagello et al [17 ▪▪ ] published a randomized, double-blinded, placebo-controlled trial assessing a single-dose of tranexamic acid in patients undergoing PCNL.…”