Tranexamic acid for percutaneous nephrolithotomy

Cleveland, Brent; Norling, Brett; Wang, Hill; Gandhi, Vardhil; Price, Carrie; Borofsky, Michael S.; Pais, Vernon M.; Dahm, Philipp

doi:10.1002/14651858.cd015122

Cited by 3 publications

(4 citation statements)

References 67 publications

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“…Because of the sparse data and relative infrequency of topical TXA use compared to systemic use, the analysis was omitted from the present report. Additional information regarding this intervention can be found in the published Cochrane review [25].…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…This systematic review and meta‐analysis is based on a published protocol [25] and a comprehensive search strategy of multiple databases from their inception to 19 May 2021. A more detailed description of the methods can also be found in the published, full‐length Cochrane review [25]. This search was rerun on 16 February 2022, 2 August 2022, and 11 May 2023 within 3 months prior to anticipated publication of the review.…”

Section: Methodsmentioning

confidence: 99%

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Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review

Cleveland,

Norling,

Wang

et al. 2023

BJU International

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ObjectiveTo assess the effects of tranexamic acid (TXA) in individuals with kidney stones undergoing percutaneous nephrolithotomy (PCNL).Patients and MethodsWe performed a literature search of Cochrane Library, PubMed (including MEDLINE), Embase, Scopus, Global Index Medicus, trials registries, grey literature, and conference proceedings. We included randomised controlled trials (RCTs) that compared treatment with PCNL with administration of TXA to placebo (or no TXA) for patients aged ≥18 years. Two review authors independently classified studies and abstracted data. Primary outcomes were blood transfusion, stone‐free rate (SFR), thromboembolic events (TEE). We rated the certainty of evidence (CoE) according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach using a minimally contextualised approach with pre‐defined thresholds for minimally clinically important differences (MCID).ResultsWe included 10 RCTs assessing the effect of systemic TXA in PCNL vs placebo (or no TXA). Eight studies were published as full text. Based on an adjusted baseline risk of blood transfusion of 5.7%, systemic TXA may reduce blood transfusions (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.27–0.76). Based on an adjusted baseline SFR of 75.7%, systemic TXA may increase SFR (RR 1.11, 95% CI 0.98–1.27). There is probably no difference in TEEs (risk difference 0.001, 95% CI −0.01 to 0.01). Systemic TXA may increase adverse events (AEs) (RR 5.22, 95% CI 0.52–52.72). Systemic TXA may have little to no effect on secondary interventions (RR 1.15, 95% CI 0.84–1.57). The CoE for most outcomes was assessed as low or very low.ConclusionsBased on a body of evidence of 10 RCTs, we found that systemic TXA in PCNL may reduce blood transfusions, major surgical complications, and hospital length of stay, as well as improve the SFR; however, it may increase AEs. These findings should inform urologists and their patients in making informed decisions about the use of TXA in the setting of PCNL.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review

Cleveland,

Norling,

Wang

et al. 2023

BJU International

View full text Add to dashboard Cite

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“…Risks and adverse outcomes associated with PCNL include postoperative pain, fever, infection (including risk of sepsis), haemorrhage (including potential need for blood transfusion), renal collecting system injury or obstruction (or both), injury to surrounding organs (including colon, spleen, liver, and diaphragm and associated pleura), renal dysfunction, extravasation/urine leak, and mortality [9][10][11][12][13][14]. Recently, tranexamic acid, an antifibrinolytic agent, has found off label use to reduce the need for blood transfusions during PCNL [15].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review

Soderberg,

Ergun,

Ding

et al. 2023

BJU International

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ObjectivesTo assess the effects of PCNL versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.MethodsWe performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceeding up to March 23, 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk of bias assessment and certainty of evidence (CoE) rating using GRADE were done in duplicate by two independent reviewers. This co‐publication focuses on the primary outcomes of this review only.ResultsWe included 42 trials that met the inclusion criteria.Stone free rate: PCNL may improve stone‐free rates (RR 1.13, 95% CI 1.08 to 1.18; I2 = 71%; 39 studies, 4088 participants; low CoE).Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59 to 1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS.Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17 to 0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS.ConclusionDespite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve stone‐free rates and reduce the need for secondary interventions while not impacting major complications. Ureteral stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision‐making about management choices for individuals with renal stones.

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