Roles of tranexamic acid on bleeding in percutaneous nephrolithotomy procedure: A systematic review and meta-analysis

Purpose: Bleeding is the most common percutaneous nephrolithotomy (PCNL) complication. We investigated the role of tranexamic acid (TXA), which has numerous benefits in trauma and elective surgery, in PCNL. Materials and methods: Systematic reviews were performed using PubMed, Science Direct, Scopus, and Google Scholar. This study included randomized clinical trials that compared the effects of TXA and placebo during PCNL. The publication date, which was a limitation of the study, was disregarded. The analysis only included studies published in English that were available in full text. Patients with kidney stones who underwent PCNL were also enrolled. The outcomes comprised blood loss, hemoglobin decrease, blood transfusion rate, and length of hospital stay. Results: A total of 1377 patients from 8 studies were included. TXA was correlated with a low rate of blood transfusion (odds ratio = 0.35 [0.22-0.56]; P < 0.00001), blood loss (mean difference [MD] = -66.88 mL [-101.54 to -32.23]; P = 0.0002), decreased hemoglobin levels (MD = -0.67 g/dL [-0.96 to -0.38]; P < 0.00001), and reduced length of hospital stay (MD = -0.61 day [-1.04 to -0.18]; P = 0.005). Conclusion: The promising roles of TXA in PCNL procedures have been revealed. Further studies involving additional clinical trials, particularly those that assess interactions and adaptations to patients' comorbidities, are suggested.