Izawa Junichi, Matsuzaki Keiichi, Raita Yoshihiko, Uehara Genta, Nishioka Norihiro, Yano Hiroyuki, Sudo Ko, Katsuren Masato, Ohigashi Tomohiro, Sozu Takashi, Kawamura Takashi, Miyasato Hitoshi
Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan.
Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
Nephron. 2023;147(3-4):144-151. doi: 10.1159/000526325. Epub 2022 Sep 9.
Tranexamic acid is frequently reported to reduce bleeding-related complications in major surgery and trauma. We aimed to investigate whether tranexamic acid reduced hematoma size after percutaneous kidney biopsy.
We conducted a double-blind, parallel three-group, randomized placebo-controlled trial at a teaching hospital in Japan between January 2016 and July 2018. Adult patients with clinical indication for ultrasound-guided percutaneous biopsy of a native kidney were included. Participants were randomly assigned into three groups: high-dose tranexamic acid (1,000 mg in total), low-dose tranexamic acid (500 mg in total), or placebo (counterpart saline). Intervention drugs were intravenously administered twice, as a bolus just before the biopsy and as a continuous infusion initiated just after the biopsy. Primary outcome was post-biopsy perirenal hematoma size as measured by ultrasound on the morning after the biopsy.
We assessed 90 adult patients for study eligibility, of whom 56 were randomly allocated into the three groups: 20 for high-dose tranexamic acid, 19 for low-dose tranexamic acid, and 17 for placebo. The median size of perirenal hematoma was 200 mm2 (interquartile range, 21-650) in the high-dose tranexamic acid group, 52 mm2 (0-139) in the low-dose tranexamic acid group, and 0 mm2 (0-339) in the placebo group (p = 0.048 for high-dose tranexamic acid vs. placebo).
In this trial, the median size of post-kidney biopsy hematoma was unexpectedly larger in the high-dose tranexamic acid group than in the placebo group. Although our results do not support the routine use of tranexamic acid in percutaneous kidney biopsy at present, further studies are needed to confirm the results.
氨甲环酸常被报道可减少大手术和创伤中与出血相关的并发症。我们旨在研究氨甲环酸是否能减小经皮肾穿刺活检后的血肿大小。
2016年1月至2018年7月，我们在日本一家教学医院进行了一项双盲、平行三组、随机安慰剂对照试验。纳入有超声引导下对天然肾进行经皮活检临床指征的成年患者。参与者被随机分为三组：高剂量氨甲环酸组（共1000毫克）、低剂量氨甲环酸组（共500毫克）或安慰剂组（等量生理盐水）。干预药物静脉注射两次，一次在活检前推注，一次在活检后立即开始持续输注。主要结局是活检后次日早晨通过超声测量的活检后肾周血肿大小。
我们评估了90名成年患者的研究资格，其中56名被随机分配到三组：20名接受高剂量氨甲环酸，19名接受低剂量氨甲环酸，17名接受安慰剂。高剂量氨甲环酸组肾周血肿的中位数大小为200平方毫米（四分位间距，21 - 650），低剂量氨甲环酸组为52平方毫米（0 - 139），安慰剂组为0平方毫米（0 - 339）（高剂量氨甲环酸组与安慰剂组相比，p = 0.048）。
在本试验中，高剂量氨甲环酸组肾穿刺活检后血肿的中位数大小意外地大于安慰剂组。尽管我们的结果目前不支持在经皮肾穿刺活检中常规使用氨甲环酸，但仍需要进一步研究来证实这些结果。
