Systemic vs. in-irrigation tranexamic acid in percutaneous nephrolithotomy

A systematic review, Bayesian network meta-analysis, and meta-regression

Authors

  • David E. Hinojosa-Gonzalez Scott Department of Urology, Baylor College of Medicine, Houston, Texas
  • Bhaskar Somani University Hospital Southampton NHS Foundation Trust, Southampton, UK
  • Daniel Olvera-Posada Hospital Zambrano Hellion, Nuevo León, México
  • Michal Segall Albert Einstein College of Medicine, Bronx, NY
  • Juliana Villanueva-Congote Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • Brian H. Eisner Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

DOI:

https://doi.org/10.5489/cuaj.8721

Keywords:

Systematic Review, Nephrolithiasis, Controlled Clinical Trial, Nephrolithotomy, Percutaneous, Tranexamic Acid

Abstract

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal stones. One potentially significant complication of PCNL is blood loss, which can result in transfusion requirement and poorer stone-free outcomes. Tranexamic acid (TXA) has emerged as a promising intervention, administered systemically (TXA-S) or as part of irrigation fluid (TXA-I) in endourology. This study aimed to comprehensively analyze existing evidence regarding the applications of TXA in PCNL through a Bayesian network meta-analysis, offering insights into its efficacy and comparative effectiveness.

METHODS: In February 2022, a PRISMA-compliant systematic review (PROSPERO registration number CRD42021270593) was performed to identify randomized controlled clinical trials (RCT) on TXA as either systemic therapy or in irrigation fluid. Studies in languages other than English and Spanish were not considered. A Bayesian network was built using results from identified studies to create models that were later run through Markov Chain Monte Carlo sampling through 200 000 iterations.

RESULTS: Eight RCTs compared TXA-S vs. placebo, one TXA-I vs. placebo, and one TXA-I vs. TXA-S. TXA-I had lower risk of transfusion (relative risk [RR] 0.63 [0.47,0.84], SUCRA 0.950) than TXA-S (RR 0.79 [0.65,0.95], SUCRA 0.545). TXA-I had a lower risk of complications (RR 0.38 [0.21,0.67], SUCRA=0.957) compared to TXA-S (RR 0.55 [0.39, 0.78], SUCRA 0.539). TXA-I had a lower postoperative decrease in hemoglobin (mean difference [MD] -1.2 [1.3, 1.0], SUCRA 0.849) compared to TXA-S (MD-0.97 [-1.0, -0.93], SUCRA 0.646]).

CONCLUSIONS: TXA, regardless of the route of administration, is an effective intervention in decreasing bleeding, postoperative complications, and risk of transfusion when compared with placebo. Further studies directly comparing TXA-S to TXA-I would be useful to determine the optimal route of delivery.

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Published

2024-05-21

How to Cite

Hinojosa-Gonzalez , D. E. ., Somani , B. ., Olvera-Posada , D. ., Segall, M., Villanueva-Congote, J., & H. Eisner , B. . (2024). Systemic vs. in-irrigation tranexamic acid in percutaneous nephrolithotomy: A systematic review, Bayesian network meta-analysis, and meta-regression. Canadian Urological Association Journal, 18(9), E285–90. https://doi.org/10.5489/cuaj.8721

Issue

Vol. 18 No. 9 (2024): CUAJ September

Section

Review

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