Tranexamic Acid Use for Hemorrhagic Events Prevention in Percutaneous Nephrolithotomy: Systematic Review and Meta-Analysis

Baccaglini, Willy; Rodrigues, Antônio Flávio Silva; Glina, Felipe PA; Dall'Aqua, Vinicius; Glina, Sidney; Neto, Antônio Corrêa Lopes

doi:10.1089/end.2021.0792

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Several systematic reviews [22,24,[47][48][49][50][51] have focused on the use of TXA in the PCNL setting, but most have serious methodological limitations and none to date has rated the CoE on a per-outcome basis. Multiple reviews [47][48][49][50][51] found TXA may reduce hospital length of stay GRADE Working Group grades of evidence: 'High certainty': we are very confident that the true effect lies close to that of the estimate of the effect. 'Moderate certainty': we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.…”

Section: Discussionmentioning

confidence: 99%

“…Two reviews [22,50] use the outdated Jadad system for addressing study quality. Three of these studies utilised a registered protocol [47,48,51] whereas the others did not. Importantly, TEE were not considered as an outcome of interest in three reviews [49][50][51].…”

Section: Discussionmentioning

confidence: 99%

“…Several systematic reviews [22,24,47–51] have focused on the use of TXA in the PCNL setting, but most have serious methodological limitations and none to date has rated the CoE on a per‐outcome basis. Multiple reviews [47–51] found TXA during PCNL beneficial for patient outcomes including reduced blood transfusion, improved SFR, and reduced operative time, and reduced complication rates. None of these reviews utilised a formalised approach to rating CoE.…”

Section: Discussionmentioning

confidence: 99%

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Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review

Cleveland,

Norling,

Wang

et al. 2023

BJU International

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ObjectiveTo assess the effects of tranexamic acid (TXA) in individuals with kidney stones undergoing percutaneous nephrolithotomy (PCNL).Patients and MethodsWe performed a literature search of Cochrane Library, PubMed (including MEDLINE), Embase, Scopus, Global Index Medicus, trials registries, grey literature, and conference proceedings. We included randomised controlled trials (RCTs) that compared treatment with PCNL with administration of TXA to placebo (or no TXA) for patients aged ≥18 years. Two review authors independently classified studies and abstracted data. Primary outcomes were blood transfusion, stone‐free rate (SFR), thromboembolic events (TEE). We rated the certainty of evidence (CoE) according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach using a minimally contextualised approach with pre‐defined thresholds for minimally clinically important differences (MCID).ResultsWe included 10 RCTs assessing the effect of systemic TXA in PCNL vs placebo (or no TXA). Eight studies were published as full text. Based on an adjusted baseline risk of blood transfusion of 5.7%, systemic TXA may reduce blood transfusions (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.27–0.76). Based on an adjusted baseline SFR of 75.7%, systemic TXA may increase SFR (RR 1.11, 95% CI 0.98–1.27). There is probably no difference in TEEs (risk difference 0.001, 95% CI −0.01 to 0.01). Systemic TXA may increase adverse events (AEs) (RR 5.22, 95% CI 0.52–52.72). Systemic TXA may have little to no effect on secondary interventions (RR 1.15, 95% CI 0.84–1.57). The CoE for most outcomes was assessed as low or very low.ConclusionsBased on a body of evidence of 10 RCTs, we found that systemic TXA in PCNL may reduce blood transfusions, major surgical complications, and hospital length of stay, as well as improve the SFR; however, it may increase AEs. These findings should inform urologists and their patients in making informed decisions about the use of TXA in the setting of PCNL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review

Cleveland,

Norling,

Wang

et al. 2023

BJU International

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“…Another feared complication of PCNL is bleeding, regardless of tract size, with the CROES study reporting an overall bleeding risk of 7.8% [12]. Tranexamic acid has gained immense popularity of the 2 years with multiple studies showing a decrease in bleeding and increase in stone-free rate [13–16,17 ▪▪ ,18]. Batagello et al [17 ▪▪ ] published a randomized, double-blinded, placebo-controlled trial assessing a single-dose of tranexamic acid in patients undergoing PCNL.…”

Section: Bleedingmentioning

confidence: 99%

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

Stern¹

2023

Current Opinion in Urology

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Purpose of reviewPercutaneous nephrolithotomy (PCNL) continues as the gold standard for the surgical management of large renal stones. This short review is intended to highlight recent publications on PCNL of all tract sizes, from mini to standard. Recent findingsLiterature on PCNL in the last 2 years has focused on several main themes --decreasing complications, improving postoperative pain control, and new technology to improve outcomes. Mini-PCNL continues to prove effective and safe, with a new vacuum sheath showing promise of improving stone-free rates and decreasing infections. In terms of infections, preoperative midstream urine culture continues to be a poor indicator of postoperative infection. One of the biggest changes to PCNL practice is the reintroduction of tranexamic acid, which has shown to significantly decrease bleeding and improve outcomes. In terms of postoperative pain control, local blocks are effective and low risk.

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