Tranexamic Acid Reduces Blood Loss During Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Study

Kumar, Santosh; Randhawa, Manjinder Singh; Ganesamoni, Raguram; Singh, Shrawan Kumar

doi:10.1016/j.juro.2012.10.115

Cited by 67 publications

(75 citation statements)

References 21 publications

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“…Table lists the included RCTs, the year and journal of publication, the outcome considered, as well as the reported sample size, P value, and calculated Fragility Index. The median sample size (interquartile range [IQR]) was 99 (65, 179), whilst the median (IQR) event rate per study outcome was 38 (24, 65).…”

Section: Resultsmentioning

confidence: 99%

The fragility of statistically significant findings from randomised controlled trials in the urological literature

et al. 2018

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The results of urology RCTs that study dichotomous outcomes and report statistically significant differences between groups are sometimes fragile and depend on few events. Urologists should interpret these RCTs cautiously, particularly when the number of participants lost to follow-up exceeds the Fragility Index. Routine reporting of Fragility Index values alongside P values may provide additional guidance about the robustness of statistically significant findings.

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Section: Resultsmentioning

confidence: 99%

The fragility of statistically significant findings from randomised controlled trials in the urological literature

et al. 2018

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“…Initial attempts with minimal stent manipulation resulted in recurrent clot anuria. Tranexamic acid has been shown to effectively reduce bleeding in transurethral resection of prostate,13 radical retropubic prostatectomy14 and in percutaneous nephrolithotomy 15. However, using tranexamic acid in the setting of a solitary functioning kidney for management of ongoing mild haematuria led to clot anuria in this case.…”

Section: Discussionmentioning

confidence: 79%

“…However, using tranexamic acid in the setting of a solitary functioning kidney for management of ongoing mild haematuria led to clot anuria in this case. Kumar et al ,15 in 2013, also had two cases with solitary kidney that had clot anuria following use of tranexamic acid to reduce bleeding in percutaneous nephrolithotomy. Both of these cases were managed by stent replacement, as there was no issue of anastomotic disruption.…”

Section: Discussionmentioning

confidence: 99%

Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

et al. 2014

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Clot anuria in a solitary functioning kidney is an emergency situation. Haematuria with clot anuria in an early postoperative period represents a challenge, as treatment options are limited. Manipulation of the anastomotic site may lead to anastomotic disruption and urinoma while use of thrombolytic therapy poses the danger of increasing haematuria. We report a case of anuria due to clot retention in the upper tract following laparoscopic dismembered pyeloplasty in a solitary functioning kidney, managed successfully with double guide wire technique.

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“…Furthermore, lack of national and international data on use of TA in this particular urological surgery highlights the need for the above mentioned notion. There is only one study performed internationally by Kumar et al (22). Other than that, there are 2 reviews by other authors pertaining to the same study.…”

Section: Introductionmentioning

confidence: 99%

“…Other than that, there are 2 reviews by other authors pertaining to the same study. Fenner (23) in 2013, has commented on the study of Kumar et al (22) and has re-emphasized the use of TA in selected group of patients in whom prolonged operative time is anticipated. Ritter and Michel (24) has also commented on the study of Kumar et al (22) in 2013 with similar remarks but pointed out few pitfalls in the study like the confounding factors for perioperative and postoperative bleeding which were never discussed in the study and that type and technique of puncture which is a very important predictor of intraoperative hemorrhage, was also never discussed.…”

Section: Introductionmentioning

confidence: 99%

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

Siddiq¹,

Khalid²,

Mithani³

et al. 2017

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Objective: Percutaneous nephrolithotomy (PCNL) is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA) would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI), stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb) and hematocrit (Hct) levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05). Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR) 4, while in TA group was 1.3 (IQR 7.8) (p=0.001). Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8) and in TA group was 2.4 (IQR 13) (p<0.001). Sixteen patients were transfused after surgery; 12 (75%) belonged to placebo group while 4 (25%) belonged to TA group (p=0.038). Hospital stay was not significantly different in both groups (p=0.177) with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.Amaç: Perkütan nefrolitotomi (PNL), 2 cm ve daha büyük böbrek taşları için en sık uygulanan prosedürdür. Perioperatif kanama en yaygın komplikasyon olup, istenmeyen sonuçların öngörülen önemli faktörüdür. Traneksamik asit (TA) gibi ucuz ve güvenli ilaçlarla önleme, nihayetinde gelecek kılavuz ilkeleri oluşturmak için temel taş haline dönüşebilir. Bu çalışmanın amacı, TA'nın PNL sırasında kan kaybını önlemede etkili olup olmadığını değerlendirmektir. Abstract Öz What's known on the subject? and What does the study add?Percutaneous nephrolithotomy is most frequently performed procedure for renal stones measuring 2 cm. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive safe drug like Tranexamic acid would ultimately turn out to be cornerstone for establishing future guidelines. Currently there is only one study published internationally highlighting this notion. Therefore this study will be beneficial for researchers in shaping the current practices.

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Tranexamic Acid Reduces Blood Loss During Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Study

Abstract: The use of tranexamic acid in percutaneous nephrolithotomy is safe, and is associated with reduced blood loss and a lower complication rate.

Cited by 67 publications

References 21 publications

The fragility of statistically significant findings from randomised controlled trials in the urological literature

The fragility of statistically significant findings from randomised controlled trials in the urological literature

Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

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