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Meta-Analysis
. 2023 Feb;105(2):99-106.
doi: 10.1308/rcsann.2021.0259. Epub 2022 Apr 21.

Is tranexamic acid associated with decreased need for blood transfusion in percutaneous nephrolithotomy: a systematic review and meta-analysis

S Prasad  1 , G Sharma  2 , S Kumar Devana  2 , S Kumar  2 , S Sharma  3
Affiliations
Meta-Analysis

Is tranexamic acid associated with decreased need for blood transfusion in percutaneous nephrolithotomy: a systematic review and meta-analysis

S Prasad et al. Ann R Coll Surg Engl. 2023 Feb.

Abstract

Introduction: Bleeding is a common complication after percutaneous nephrolithotomy (PNL) for renal stone disease. Tranexamic acid (TXA) has been found to reduce mortality and blood transfusion in surgical and trauma patients. This review aimed to assess the safety and efficacy of TXA in patients undergoing PNL.

Methods: A systematic literature review was performed to recognise all randomised controlled trials (RCTs) comparing the use of TXA in PNL. The primary outcome of the study was to compare the need for blood transfusion with and without TXA.

Findings: Six RCTs with 1,323 patients were included in this review. Haemoglobin fall was lower in the TXA group compared with the control group, and the need for blood transfusion was reduced by 67% (odds ratio (OR) 0.33, confidence interval (CI) (0.21, 0.52), p<0.00001). However, blood loss was comparable for the two groups (mean difference -116.9, CI (-244.5,10.7) p=0.07). Length of stay and duration of surgery was significantly shorter with TXA. Furthermore, both minor and major complications were lower in the TXA group. Stone-free rate was higher with the TXA group. No thromboembolic complications were noted in the TXA group.

Conclusions: TXA is safe and efficacious for PNL with a reduction in need for blood transfusion and without an attending increase in complication rates.

Keywords: Meta-analysis; Percutaneous nephrolithotomy; Tranexamic acid.

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Figures

Figure 1
Figure 1
PRISMA-flow chart depicting search strategy used for this review. PRISMA = Preferred Reporting Items for Systematic reviews and Meta-analysis
Figure 2
Figure 2
Risk of bias summary and graph for the studies included in this review
Figure 3
Figure 3
Forest plot comparing TXA group and control group for blood loss, blood transfusion, operative time and haemoglobin fall. TXA = Tranexamic acid
Figure 4
Figure 4
Forest plot comparing TXA group and placebo group for complications, stone-free rate and hospital stay. TXA = Tranexamic acid
See this image and copyright information in PMC

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