Chandigarh: A prospective randomized controlled study conducted by doctors at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh has found that tranexamic acid reduces blood loss in percutaneous nephrolithotomy (PCNL).
PCNL is a surgical procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the Pelvic region. It is usually done under general anaesthesia or spinal anaesthesia.
The study, led by Dr Santosh Kumar, assistant professor, department of urology, PGIMER, was conducted to evaluate the safety and efficacy of the anti-fibrinolytic agent tranexamic acid in reducing blood loss and surgical complication in patients undergoing PCNL.
The study findings have been published in the Journal of Urology.
For the study, a total of 200 patients planned for PCNL were randomized into two equal groups. Patients in tranexamic acid group received one gram of tranexamic acid at induction followed by three oral doses of 500 mg over 24 hours, while those in control group did not receive tranexamic acid.
Patient demographics and clinical data of the two groups were compared. The baseline patient demographics were similar in both the groups. The mean haemoglobin drop in the tranexamic acid was significantly lower than that of the control group (1.39 vs 2.31 g/dL, p < 0.0001).
Mean operative time in tranexamic acid group was significantly lower than that of control group (48.3 min vs 70.8 min, p < 0.0001). Stone clearance rate was similar in both the groups (91% vs 82%, p = 0.06). The blood transfusion rate was lower in the tranexamic acid group (2% vs 11%, p = 0.018).
The complication rate was lower in tranexamic acid group (33% vs 59%, p < 0.0001). Two patients with solitary functioning kidney in tranexamic acid group required ureteric stenting to relieve anuria due to clot obstruction.
Kidney stone is an increasingly common problem with a current worldwide incidence of 12 per cent. PCNL endoscopic stone surgery is a minimally invasive procedure for removal of renal and upper ureteral stone.
Kidneys receive 25 per cent of blood that heart pumps into body. Bleeding is a significant morbidity during PCNL with reports quoting an average haemoglobin drop ranging from 2-3.3gm/dl. As a result, 1-11 per cent of patients overall and 2-33 per cent of those with staghorn calculi require blood transfusion.
Blood loss and associated blood transfusion increases patients’ morbidity and hospital stay, even mortality. It increases further intervention and increases cost of treatment. Blood is a precious commodity and its judicious use increases its availability for life-threatening conditions.
Dr Santosh Kumar concluded from the study that the use of tranexamic acid in PCNL is “safe” and is “effective in reducing blood loss in PCNL and is associated with less intra-operative and peri-operative complications”.
“Therefore peri-operative administration of tranexamic acid may be advised for those patients in whom there is no contraindication. It is likely to be beneficial in those cases in which prolonged operative time is anticipated for Percutaneous Nephrolithotomy (endoscopic stone surgery),” says Dr Santosh Kumar.
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