PMID- 38037865
OWN - NLM
STAT- MEDLINE
DCOM- 20240220
LR  - 20240220
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 133
IP  - 3
DP  - 2024 Mar
TI  - Tranexamic acid for percutaneous nephrolithotomy: an abridged Cochrane review.
PG  - 259-272
LID - 10.1111/bju.16244 [doi]
AB  - OBJECTIVE: To assess the effects of tranexamic acid (TXA) in individuals with 
      kidney stones undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND 
      METHODS: We performed a literature search of Cochrane Library, PubMed (including 
      MEDLINE), Embase, Scopus, Global Index Medicus, trials registries, grey 
      literature, and conference proceedings. We included randomised controlled trials 
      (RCTs) that compared treatment with PCNL with administration of TXA to placebo 
      (or no TXA) for patients aged >/=18 years. Two review authors independently 
      classified studies and abstracted data. Primary outcomes were blood transfusion, 
      stone-free rate (SFR), thromboembolic events (TEE). We rated the certainty of 
      evidence (CoE) according to the Grading of Recommendations, Assessment, 
      Development, and Evaluation (GRADE) approach using a minimally contextualised 
      approach with pre-defined thresholds for minimally clinically important 
      differences (MCID). RESULTS: We included 10 RCTs assessing the effect of systemic 
      TXA in PCNL vs placebo (or no TXA). Eight studies were published as full text. 
      Based on an adjusted baseline risk of blood transfusion of 5.7%, systemic TXA may 
      reduce blood transfusions (risk ratio [RR] 0.45, 95% confidence interval [CI] 
      0.27-0.76). Based on an adjusted baseline SFR of 75.7%, systemic TXA may increase 
      SFR (RR 1.11, 95% CI 0.98-1.27). There is probably no difference in TEEs (risk 
      difference 0.001, 95% CI -0.01 to 0.01). Systemic TXA may increase adverse events 
      (AEs) (RR 5.22, 95% CI 0.52-52.72). Systemic TXA may have little to no effect on 
      secondary interventions (RR 1.15, 95% CI 0.84-1.57). The CoE for most outcomes 
      was assessed as low or very low. CONCLUSIONS: Based on a body of evidence of 10 
      RCTs, we found that systemic TXA in PCNL may reduce blood transfusions, major 
      surgical complications, and hospital length of stay, as well as improve the SFR; 
      however, it may increase AEs. These findings should inform urologists and their 
      patients in making informed decisions about the use of TXA in the setting of 
      PCNL.
CI  - (c) 2023 The Authors. BJU International published by John Wiley & Sons Ltd on 
      behalf of BJU International.
FAU - Cleveland, Brent
AU  - Cleveland B
AD  - Department of Urology, University of Minnesota, Minneapolis, MN, USA.
AD  - Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.
FAU - Norling, Brett
AU  - Norling B
AUID- ORCID: 0000-0002-6352-9716
AD  - University of Minnesota Medical School, Minneapolis, MN, USA.
FAU - Wang, Hill
AU  - Wang H
AD  - University of Minnesota Medical School, Minneapolis, MN, USA.
FAU - Gandhi, Vardhil
AU  - Gandhi V
AD  - University of Alberta, Edmonton, AB, Canada.
FAU - Price, Carrie L
AU  - Price CL
AD  - Albert S. Cook Library, Towson University, Towson, MD, USA.
FAU - Borofsky, Michael
AU  - Borofsky M
AD  - Department of Urology, University of Minnesota, Minneapolis, MN, USA.
AD  - Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.
FAU - Pais, Vernon
AU  - Pais V
AD  - Department of Surgery, Section of Urology, Dartmouth-Hitchcock Medical Center, 
      Lebanon, NH, USA.
FAU - Dahm, Philipp
AU  - Dahm P
AUID- ORCID: 0000-0003-2819-2553
AD  - Department of Urology, University of Minnesota, Minneapolis, MN, USA.
AD  - Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20231225
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
RN  - 6T84R30KC1 (Tranexamic Acid)
SB  - IM
MH  - Humans
MH  - Adolescent
MH  - Adult
MH  - *Tranexamic Acid/therapeutic use
MH  - *Nephrolithotomy, Percutaneous/adverse effects
MH  - Blood Transfusion
MH  - *Thromboembolism/drug therapy
MH  - *Kidney Calculi/surgery/drug therapy
OTO - NOTNLM
OT  - adverse events
OT  - blood loss
OT  - percutaneous nephrolithotomy
OT  - systematic reviews
OT  - tranexamic acid
EDAT- 2023/12/01 06:44
MHDA- 2024/02/20 11:50
CRDT- 2023/12/01 05:30
PHST- 2024/02/20 11:50 [medline]
PHST- 2023/12/01 06:44 [pubmed]
PHST- 2023/12/01 05:30 [entrez]
AID - 10.1111/bju.16244 [doi]
PST - ppublish
SO  - BJU Int. 2024 Mar;133(3):259-272. doi: 10.1111/bju.16244. Epub 2023 Dec 25.