Re-evaluation of the efficacy of tranexamic acid in reducing blood loss in percutaneous nephrolithotomy: a randomized clinical trial

Sichani, Mehrdad Mohammadi; Kazemi, Reza; Nouri-Mahdavi, Kia; Gholipour, Farshad

doi:10.23736/s0393-2249.18.03151-x

Cited by 20 publications

(17 citation statements)

References 25 publications

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“…Difference in Hb levels also showed significant heterogeneity (I 2 ¼ 85%, P ¼ 0.002). After removing the study by Sichani et al, 25 the heterogeneity was I 2 ¼ 0%, which was not significant.…”

Section: Sensitivity Analysismentioning

confidence: 79%

“…Finally, six RCTs that satisfied the inclusion criteria were included in this metaanalysis. [20][21][22][23][24][25] The article selection process was completed in accordance with the PRISMA statement (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Kumar et al 20 administered three 500mg doses of TXA orally every 8 hours while Cauni et al 23 used the same dose regimen, but repeated it every 12 hours post-surgery. Sichani et al 25 administered 1 g of TXA at the start of the procedure followed by 1 g of TXA every 8 hours for the first 48 hours. All six of the included RCTs reported blood transfusion events, but data from only three of the RCTs was adequate to determine the change in hemoglobin (Hb).…”

Section: Resultsmentioning

confidence: 99%

“…All six of the included RCTs reported blood transfusion events, but data from only three of the RCTs was adequate to determine the change in hemoglobin (Hb). 20,21,25 Four RCTs reported the length of hospital stay and operative time. 20,21,23,25 Two RCTs reported stone clearance.…”

Section: Resultsmentioning

confidence: 99%

“…20,21,25 Four RCTs reported the length of hospital stay and operative time. 20,21,23,25 Two RCTs reported stone clearance. 20,21 Jadad scores for five of the studies varied from 3 to 5, and all six studies were highquality RCTs based on the quality assessment.…”

Section: Resultsmentioning

confidence: 99%

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Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

Wang

Bai

et al. 2020

J Int Med Res

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Objective A systematic review and meta-analysis was conducted to explore the efficacy of tranexamic acid (TXA) in reducing transfusion events in patients undergoing percutaneous nephrolithotomy (PCNL). Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases from January 1980 to October 2019 were searched for randomized controlled trials (RCTs) that assessed TXA efficacy in reducing transfusion events during PCNL. Intervention treatments include using TXA compared with placebo (or no intervention) for patients who underwent PCNL. The search strategy and study selection process were managed in accordance with the PRISMA statement. Results Six RCTs are included in the meta-analysis. Overall, TXA intervention groups showed a significant reduction in blood transfusion events (RR = 0.34; 95% confidence interval [CI] = 0.19 to 0.62), hemoglobin decrease (MD = −0.80; 95% CI = −1.32 to −0.28), operative time (MD = −12.62; 95% CI = −15.62 to −9.61), and length of hospital stay (MD = −0.73; 95% CI = −1.36 to −0.10) compared with control groups after PCNL. However, TXA had no substantial impact on the rate of stone clearance (RR = 1.10; 95% CI = 1.00 to 1.21). Conclusions TXA can effectively reduce the transfusion rate and blood loss during PCNL.

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Section: Sensitivity Analysismentioning

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

Wang

Bai

et al. 2020

J Int Med Res

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Tranexamic acid for percutaneous nephrolithotomy

Cleveland,

Norling,

Wang

et al. 2023

Cochrane Database of Systematic Reviews

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Re-evaluation of the efficacy of tranexamic acid in reducing blood loss in percutaneous nephrolithotomy: a randomized clinical trial

Cited by 20 publications

References 25 publications

Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Tranexamic acid for percutaneous nephrolithotomy

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