Tranexamic Acid reduces blood loss in patients with complex renal stones undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial.

Background: Bleeding remains the most common complication in patients with complex renal stones undergoing percutaneous nephrolithotomy (PCNL), contributing to increased morbidity and a higher requirement for blood transfusion. In resource-limited settings, a cost-effective non-surgical intervention such as tranexamic acid (TXA) may serve as a valuable strategy to minimize intraoperative blood loss and transfusion rates. To evaluate the safety and efficacy of intravenous TXA in reducing blood loss and transfusion requirements during PCNL for complex renal stones. Methodology: This prospective, randomized, double-blind, placebo-controlled clinical trial was conducted at a tertiary care hospital between March 2023 and September 2024. A total of 264 patients with complex renal stones were enrolled and randomly assigned into two equal groups. One group received intravenous distilled water (PCNL-placebo), while the other group was administered 1 g of intravenous tranexamic acid (PCNL-TXA). Block randomization was used for group allocation. Preoperative, intraoperative, and postoperative parameters were recorded and compared between the groups. Results: Patients in the PCNL-TXA group had significantly shorter operative times, reduced hospital stays, and a lower postoperative drop in hemoglobin and hematocrit compared to the placebo group. Although the stone clearance rate was higher in the TXA group, it did not reach statistical significance. The requirement for blood transfusion was significantly lower in the TXA group. Complications were more frequent in the placebo group, with 16 (12.1%) Clavien-Dindo Grade III events compared to 6 (4.54%) in the TXA group, mostly related to blood transfusion. Urosepsis occurred in both groups, but no patient required angioembolization. Conclusion: Intravenous administration of tranexamic acid during PCNL for complex renal stones effectively reduces intraoperative blood loss and the need for transfusion. It also contributes to shorter operative times and reduced hospital stays, offering a safe and affordable adjunct to improve surgical outcomes.