The Use of Tranexamic Acid in Percutaneous Nephrolithotomy. A Randomized Controlled Study (Local Experience)

Abstract

Purpose: To evaluate the efficacy and safety of Tranexamic acid in reducing blood loss during PCNL. Materials and Methods: A total of 50 patients who underwent unilateral Percutaneous Nephrolithotomy from March 2017 to November 2017 were randomized into 2 equal groups; group (A) who received 1 gm (10 cc) of tranexamic acid ampule on call to surgery and group (B) who received (10 cc) normal saline. The Patients clinical data were collected and recorded in Microsoft Excel 2016 and analyzed using Statistical Package for the Social Science (SPSS) version 20 software program. Results: Fifty patients were included in the study: (33 males and 17 female). The mean age in group A patients was (48.12 ± 13.58) years, and in group B was (48.88 ± 16.17) with P value = 0.858. In group A the number of males was 16 (64%), and female was 9 (36%), and in group B male was 17 (68%) and female was 8 (34%). Mean body mass index (BMI) in group A was (28.58 ± 4.51) and in group B was (26.72 ± 3.71), with P value = 0.119 which is statistically not significant. The mean total blood loss in milliliters in group A was (73.80 ± 60.1), while in group B it was (117.24 ± 87.9) which is statistically significant with P-Value = 0.047. The mean hemoglobin drop in group A was (0.45 ± 0.35 g/dl) while in group B was (1.00 ± 0.46 g/dl), which is statistically significant with P value = 0.0001. The mean operative time was (48.4 ± 17) minute in group A, while it was (62.4 ± 15) in group B, with P-Value = 0.005, which is statistically was significant. Post-operative hematuria in group A; 20 (80%) patients had mild hematuria, 3 (12%) patients had moderate hematuria and 2 patients (8%) had no hematuria. In group B; 18 (72%) patients had mild hematuria, 6 (24%) patients had moderate hematuria and one patient (4%) had no hematuria, which is statistically not significant with P-Value = 0.487 ( Table 2 ). One patient (4%) had intra operative bleeding in group A, in group B two patients (8%) had bleeding with P value of 0.79 which statistically not significant. Conclusion: Tranexamic acid is safe and effective drug in reducing blood loss and the rate of blood transfusion in percutaneous nephrolithotomy. It is associated with fewer intraoperative, postoperative complications and shorter operative time.