The effects of antifibrinolytic drug use in decreasing hemoglobin drop following Percutaneous Nephrolithotomy in Al-Hillah Province

Abstract

Introduction: Objective: To assess the effectiveness and safety of tranexamic acid in lowering postoperative haemoglobin and hematocrit decline, operational time, postoperative complications, and hospitalisation in percutaneous nephrolithotomy patients. Methods: A 40-patient Al-Hilla Teaching Hospital randomised controlled clinical trial ran from January 2020 through July 2022. All ultrasound-guided PCNL patients with renal stones were randomised into two groups. Group A consisted of 20 patients (13 males and 7 females) with a mean age of (45.05 ±12.23) years who received tranexamic acid (1gm slow intravenous infusion diluted in 100 cc normal saline over 10 minutes) on call to surgery and then (0.5 gm infusion every 8 hours for the first 24 hours postoperatively). Group B included 20 non-tranexamic acid-treated patients (9 males and 11 females) with a mean age of 42.15 ± 10.64 years. We are comparing haemoglobin and hematocrit decline, operational time, postoperative complications, and hospitalisation between two groups. Results: Group A had a much lower postoperative haemoglobin decline than group B, 12.97 ±1.21 g/dl vs 11.82 ±1.44 (p = 0.010). Group A had a much lower postoperative hematocrit decline (39.11 ±3.95%) than group B (34.86 ±3.73%) (p = 0.001). 63.25 ±10.79 minutes against 73.50 ±16.31 minutes (p = 0.024). Group A had a significantly shorter hospital stay than group B (54.00 ±10.66 hours vs. 60.60 ±11.74 hours, p = 0.021). All patients in two groups had postoperative moderate hematuria, however group B had 4 (20.0%) instances of severe hematuria, whereas group A had just one (5%) case (p = 0.047). Four (20.0%) group B patients and one (5%) group A case required blood transfusion, a statistically significant difference (p = 0.047). Conclusions: TXA reduces postoperative haemoglobin and hematocrit drops and blood transfusions in PCNL with minimal side effects and a shorter operational time and hospital stay.

Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials

“…One of the included studies, conducted by Al-Najjar et al, investigated the effects of TXA on patients who underwent percutaneous nephrolithotomy. [27] The study found that patients treated with TXA had shorter operative times and fewer requirements of blood transfusion.…”