Re-evaluation of the efficacy of tranexamic acid in reducing blood loss in percutaneous nephrolithotomy: a randomized clinical trial

BACKGROUND: Tranexamic acid was reported to reduce bleeding in patients undergoing percutaneous nephrolithotomy (PCNL). The current study was performed to re-evaluate the efficacy and safety of tranexamic acid in reducing PCNL-related blood loss. METHODS: A total of 132 consecutive patients were randomized into two groups; the case group received 1 g of intravenous tranexamic acid before induction, followed by IV infusion of a fixed dose of 1 gr tranexamic acid at 8-hour intervals for the first 48 hours after the procedure, while the control group received normal saline as placebo. Demographic and clinical characteristics of patients were recorded. The collected data were then analyzed using χ2, t-test, and multivariate regression analysis with IBM SPSS Statistics software. RESULTS: There was no significant difference in demographic characteristics of the two groups. Mean hemoglobin drop was 2.2±1.5 g/dL in tranexamic acid group and 2.4±1.5 g/dL in controls (P=0.312). The blood loss did not show significant difference between tranexamic acid and control groups (751±523 mL vs. 826±525 mL, P=0.416). Multivariate analysis has revealed that multiple access tracts is a risk factor for increased blood loss (P=0.014). CONCLUSIONS: Tranexamic acid administration is not associated with significant reduction of PCNL-related blood loss. Our findings are unlike the results of few recent studies, thus warranting further investigations and new trials before the widespread use of this drug is considered safe in patients undergoing PCNL.