Effects of Tranexamic Acid on Bleeding and Hemoglobin Levels in Patients with Staghorn Calculi Undergoing Percutaneous Nephrolithotomy: Randomized Controlled Trial.

backgroundThe incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and hemoglobin levels of patients with staghorn calculi treated with PCNL.

methodsIn a double-blind clinical trial, 120 patients with staghorn calculi candidated for PCNL in Alzahra Hospital between January 2014 and November 2017, Isfahan, Iran, were classified into two groups in terms of the stone size (>4 cm and <4 cm). The patients in both groups were then randomly assigned to receive either 1 g of TXA intravenously or normal saline. (The generation of random numbers was done by computer.) Thus, there were four groups of 30 patients each. The transfusion rate, the mean volume of blood loss, the operative duration, and the hemoglobin level were compared between the intervention and control groups for each stone-size category. Statistical analysis was performed using SPSS, version 19. The paired and independent t test and the Pearson coefficient correlation were used, and a P value less than 0.05 was considered statistically significant.

resultsThe mean volume of blood loss was significantly higher in the control group patients than in those receiving TXA, in both stone-size categories (P<0.001). There was no significant difference in the postoperative hemoglobin level between the intervention and control groups, in both stone-size categories (P=0.26 and P=0.10, respectively). In addition, the mean volume of blood loss increased significantly with an increase in the operative duration (P<0.001).

conclusionTXA reduced the risk of bleeding during and after PCNL and attenuated the drop in the hemoglobin level in the postoperative period. Longer operative procedures were associated with an increase in the bleeding volume.