Role of Tranexamic Acid in Reducing Perioperative Bleeding in Patients Undergoing Percutaneous Nephrolithotomy for Complex Renal Stones – a Prospective, Randomized Study

Abstract

Background: Complex renal calculi correspond to grades III and IV of the Guy’s stone score. Percutaneous nephrolithotomy (PCNL) is considered the optimal treatment for such cases. However, bleeding and the need for blood transfusions are common complications associated with this procedure.

Objective: To evaluate the effectiveness of TXA in reducing intraoperative and postoperative bleeding as well as the rate of blood transfusions in patients undergoing PCNL for complex renal calculi. Secondary objectives included comparing operative time, complication rates, duration of hospital stay, and the complete stone-free or success rate between the two groups.

Methods: This study was a randomized, prospective, single-center investigation conducted over a 12-month period. A total of 46 patients with complex renal calculi were randomly assigned in a 1:1 ratio to either the TXA group or the control group. Patients in the TXA group received a single dose of 1 g TXA at the time of anesthesia induction during PCNL.

Results: Patients in the TXA group experienced a smaller decline in hemoglobin levels compared to the control group, both immediately after PCNL (1.27 g/dL vs. 1.6 g/dL) and 24 hours post-procedure (1.62 g/dL vs. 2.15 g/dL). The postoperative blood transfusion rate was significantly lower in the TXA group compared to the control group (4.3% vs. 21.74%). There was no statistically significant difference in operative duration, measured from calyx puncture to nephrostomy tube placement, between the two groups (71.39 minutes vs. 74.34 minutes). Similarly, no significant differences were observed in complication rates (13% vs. 17.4%) or the length of hospital stay (4.52 days vs. 4.87 days). However, the TXA group demonstrated a significantly higher overall success rate (87% vs. 52.2%) and a higher complete stone-free rate (26.08% vs. 13.04%) compared to the control group.

Conclusion: The administration of TXA in patients undergoing PCNL for complex renal calculi significantly reduces perioperative blood loss and the need for blood transfusions, without increasing the incidence of complications. It does not appear to affect operative time, or the duration of hospital stay. Furthermore, TXA use is associated with higher rates of complete stone clearance and overall success.