Pre-Procedure Tranexamic Acid for Novel Insights: Influence on Perinephric Hematoma Incidence and Hospitalization Duration in Renal Cryoablation

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This abstract was submitted to the American Urological Association (AUA) Annual Meeting (held in San Antonio, TX on May 3 - May 6, 2024) and has been accepted for a moderated poster presentation. This abstract is pending review for the Canadian Urological Association (CUA) Annual Meeting (held in Victoria, BC on June 29 - July 1, 2024) .

Abstract

INTRODUCTION:

Percutaneous renal cryoablation (PCA) is a minimally invasive alternative treatment for small renal masses. Prior research has investigated the use of tranexamic acid (TXA) in diverse urologic procedures, yet there is a no evidence regarding its application in PCA. This study assesses the efficacy of pre-operative TXA in reducing post-operative perinephric hematoma formation.

METHODS:

Patients who underwent PCA of renal masses from June 2020 to June 2023 were analyzed. Cryoprobe placement and ice-ball formation were monitored via computed tomography (CT) imaging intraoperatively. Perinephric hematoma status was determined upon review of CT imaging performed at the end of the treatment. Pre-operative IV TXA was regularly administered commencing August 2021. AIC minimized generalized linear models with a logit link function were developed for the primary outcome of post-procedural perinephric hematoma and secondary outcome of same-day discharge. A Fisher’s Exact Test was used to compare TXA and non-TXA groups.

RESULTS:

This retrospective study included 223 patients (TXA; n=118, non-TXA; n=105) with a median age of 65.8 years and median follow-up of 15 months. There were relatively fewer post-operative perinephric hematomas in the TXA group (27.1%) when compared to the non-TXA group (39.1%) (Table 1). TXA administration was associated with an OR of 0.54 [95% CI, 0.29 - 1.01; p-value = 0.055] when analyzing post-operative perinephric hematoma. Same day discharge incidence was higher in the TXA group (88.1%) relative to the non-TXA group (76.2%). TXA was associated with an OR of 2.80 [95% CI, 1.25 – 6.26; p-value = 0.013] when analyzing same day discharge, (Figure 1). The Clavien-Dindo 3+ complication rate was 1.8%, overall local recurrence rate was 0.0%, and residual disease rate was 3.1% for the aggregate cohort.

CONCLUSIONS:

This study provides novel evidence for the administration of pre-operative TXA in reducing perinephric hematoma post PCA, as well as increasing the likelihood of same day discharge.