Efficacy and safety of the tranexamic acid in reducing blood loss and transfusion requirements during percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized controlled trials.

Introduction: Percutaneous nephrolithotomy (PCNL) is a minimally invasive approach used for large kidney stones. Although tranexamic acid (TA) has the property of reducing perioperative bleeding, the effect of this drug on PCNL is equivocal. This meta-analysis was conducted to determine the efficacy and safety of TA in preventing hemorrhagic complications, transfusion requirements and other perioperative outcomes during PCNL with available randomized-controlled trials (RCTs).

Evidence acquisition: We performed a systematic review of the literature according to Cochrane guidelines for studies comparing TA and normal saline. All studies reporting the outcomes of interest were included. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.3.

Evidence synthesis: Data from three RCTs on 570 patients were included in the final meta-analysis. Patients receiving TA experienced less blood loss (MD: -0.82; 95% CI: -1.24 to -0.40; P=0.0001), fewer transfusion requirements (OR: 0.40; 95% CI: 0.01-0.76; P=0.005), lower minor complication rate (OR:0.51, 95% CI: 0.32-0.80, P=0.003), fewer major complication rate (OR:0.31, 95% CI: 0.11-0.88, p=0.03), shorter operative time (SMD: -0.39; 95% CI: -0.75 to -0.02; P=0.04) and less length of stay (LOS) (SMD: -0.68; 95% CI: -1.01 to -0.35; P<0.0001) than their counterparts during PCNL with statistically significant P value and no significant between-study heterogeneity except for LOS and operative time.

Conclusions: Our work assessing the use of TA in the clinical management of patients undergoing PCNL indicated promising results. Further well-designed trials are warranted to determine the optimal dose and indications of this drug in practice.