Tranexamic acid during myomectomy reduces intraoperative and postoperative blood loss: Study
Myomectomy can be associated with life-threatening
conditions such as bleeding. Excessive bleeding usually necessitates blood
transfusion. Interventions to reduce bleeding during myomectomy will help
reduce the need for blood transfusion with its associated complications.
Tranexamic acid has been used to reduce bleeding in other surgical procedures,
and its usage during myomectomy merits evaluation.
In view of the limited numbers of RCTs conducted on efficacy
of TXA vs. placebo, additional research on the topic of utmost importance to
consolidate the evidence from different populations is needed. Also,
considering the need to reduce blood loss during myomectomy and the need for
further work on tranexamic acid in that regard, this study was conceived.
To assess the efficacy of tranexamic acid in reducing
myomectomy-associated blood loss, a prospective double-blinded randomized trial
was conducted on women who had abdominal myomectomy. Patients were randomized
into two groups. The study group received perioperative intravenous tranexamic
acid (TXA) while the control group received a placebo. Intraoperative blood
loss was calculated by measuring the volume in the suction apparatus and
weighing the surgical swabs. In addition, blood collected postoperatively from
the wound drains and drapes were measured. Haemoglobin concentrations were
determined preoperatively and on second postoperative day for all cases. Any adverse
effect was noted in both groups.
Symptomatic uterine myomas constituted 17.3% of all
gynaecological admissions and 21.3% of gynaecological operations at Federal
Teaching Hospital Abakaliki.
The mean intraoperative blood loss among patients that had perioperative
tranexamic acid infusion was 413 6 ± 165 6 ml, while that of patients with
placebo infusion was 713 6 ± 236 3 ml.
Perioperative tranexamic acid infusion therefore reduced
mean intraoperative blood loss by 300 ml, and this was statistically significant
(SMD = −0 212, 95% CI: −403.932 to −196.067, P < 0 0001).
Perioperative tranexamic acid reduced mean total blood loss
by a value of 532.3 ml, and this is statistically significant (SMD = 30 622,
95% CI: 393.308 to 670.624, P < 0 0001).
Tranexamic acid also improved postoperative haemoglobin
concentration by 1.8 g/dl compared with placebo, and this is statistically
significant (SMD = −0 122, 95% CI: 1.182 to 2.473, P < 0 0001).
Tranexamic acid infusion decreased hospital stay by about 2
days, and this difference was statistically significant (SMD = −3 929, 95% CI:
-3.018 to –0.983, P = 0 0003). There was no adverse drug reaction in the course
of the study.
This was a double-blind RCT that determined the efficacy of
TXA in reducing blood loss during open-myomectomy surgical procedures. The
predesigned pro forma used in this study is in the appendix. The findings of
this study demonstrate that tranexamic acid (TXA) significantly reduced the intra-
and postoperative, as well as total blood loss associated with open myomectomy
in patients with symptomatic uterine fibroids in the cohort of patients
recruited. Tranexamic acid also reduced the need for blood transfusion,
improved the postoperative haemoglobin concentrations 6and reduced the duration
of hospital stay in the same participants. This is probably due to the ability
of TXA acid to reduce blood loss by inhibiting enzymatic breakdown of fibrins
in blood clots through inhibition of conversion of plasminogen to plasmin.
Tranexamic was shown, in this study, to significantly reduce
myomectomy-associated blood loss, the requirements for blood transfusion and
intraoperative time as well as the duration of admissions.
Source: Ayodele Adegbite Olaleye, Joshua Adeniyi Adebayo,
Justus Ndulue Eze; Hindawi International Journal of Reproductive Medicine
Volume 2024, Article ID 2794052, 8 pages
https://doi.org/10.1155/2024/2794052
