Posters 8: Endourology, Renal Transplant

Sunday June 26, 2022 from 07:30 to 09:00

Room: Cedar & Elm

MP-8.5 Effect of tranexamic acid on bleeding outcomes after percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized controlled trials

Liam S Power

Medical Student
Faculty of Medicine
Dalhousie University

Abstract

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

Morgan MacDonald1, Gabriela Ilie1,2,3,4, Liam Power5, Stewart Whalen1, Robin Parker6, Thomas Skinner1, Andrea G. Lantz Powers1.

1Department of Urology, Dalhousie University, Halifax, NS, Canada; 2Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; 3Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada; 4Department of Psychology, Dalhousie University, Halifax, NS, Canada; 5Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; 6Dalhousie University Libraries, Dalhousie University, Halifax, NS, Canada

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi.Among possible complications, hemorrhage and infection are the most significant and common.A plethora of high-quality studies have shown that tranexamic acid (TXA) is effective at reducing blood loss and transfusion rates in cardiac, orthopedic, gynecologic, and transplant surgeries.3-5 Studies evaluating the routine use of TXA during PCNL have shown mixed results, supporting the need for a systematic review with a thorough risk of bias assessment. The objective of this study was to review and evaluate the evidence concerning the efficacy of TXA in PCNL.

Methods: We conducted a systematic review and meta-analysis

Results: A total of 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full-text review. Of these, 11 were selected for inclusion after full article evaluations. Seven of 11 studies had a Jadad score of ≥3 and were included for data extraction (Figure 1). In total, 964 patients were included. Blood transfusion rate was significantly reduced, with a ratio for transfusion rate of 0.34 (95% confidence interval [CI] 0.19–0.61, z=3.61, p=0.0003) (Figure 2). Mean hemoglobin (Hgb) drop and operative time were both 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) (Figure 3). Reduction in operative time showed a mean difference of -8.45 minutes (95% CI -15.04 to -1.86, z=2.51, p=0.01) (Figure 4). Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 (95% CI 0.89–1.84, z=1.31, p=0.19).

Conclusions: This meta-analysis found 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.

References:

[1] Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 2016;196:1153–60.
[2] Sharma G, Pareek T, Tyagi S, et al. Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis. Sci Rep 2021;11:11811
[3] Longo MA, Cavalheiro BT, de Oliveira Filho GR. Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery. J Clin Anesth 2018;48:32–8.
[4] Cheriyan T, Maier SP, Bianco K, et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J 2015;15:752–61
[5] Topsoee MF, Bergholt T, Ravn P, et al. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy—a double-blinded randomized placebo-controlled trial. Am J Obstet Gynecol 2016;215:72.e1-72.e8



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