Effect of Topical Tranexamic Acid on Postoperative Hemoglobin Level in Patients Undergoing Percutaneous Nephrolithotomy; A Double-Blind Randomized Clinical Trial

Abstract

Background: Percutaneous nephrolithotomy is a gold standard for kidney stones larger than 2 cm in diameter. One of the complications of percutaneous nephrolithotomy is hemorrhage, for which intravenous Tranexamic acid can be used. This study was performed to compare the rate of postoperative hemoglobin decrease in patients undergoing percutaneous nephrolithotomy following topical Tranexamic acid in nephrostomy compared with control group.

Methods and materials: In this double-blind clinical trial study, 90 patients undergoing percutaneous lithotomy were randomly divided into two groups, topical Tranexamic acid and control (without Tranexamic acid injection) group. In the intervention group, 1 gr of Tranexamic acid was diluted in 100 ml of normal saline and injected into the nephrostomy drain (not intravenously) immediately after surgery. The catheter is then clamped for 30 minutes to prevent leakage of Tranexamic acid. After data collection, data were entered into SPSS version 16.

Results: The mean age of patients in this study was 45.21 years and no significant difference was observed between the two groups (P= 0.013). The rate of hemoglobin loss after surgery was significantly different from the preoperative hemoglobin level in the two groups, so that the hemoglobin loss was -1.9±1.28 in the Tranexamic acid group and -3.07±1.20 in the control group (P=0.001). In comparison between the groups estimated using independent t test, the difference in hemoglobin after surgery in the two groups was statistically significant (P = 0.001). Regarding stone free rate, the two groups had a similar condition and about 70% of patients were eventually discharged with a stone free condition. The time of surgery was not significantly different between the two groups, so that in the Tranexamic acid group it was 82.37±33.57 minutes and in the control group it was 87.15±33.39 (P <0.001).

Conclusion: This study showed that topical application of Tranexamic acid after the end of percutaneous nephrolithotomy can prevent hemoglobin loss in patients with low preoperative hemoglobin level, as well as in cases of longer surgical length or large and numerous stones which is more likely to bleed can reduce the amount of bleeding.