Hemostatics fail to check intraoperative bleeding during abdominal myomectomy

Uterine fibroids are a common health concern among women, often requiring surgical intervention for their management. Myomectomy, the surgical removal of fibroids while preserving the uterus, has been the preferred approach. However, a recent study published in BMC Women's Health found the hemostatic drugs, such as oxytocin and tranexamic acid (TA) with ethamsylate, ineffective in reducing bleeding during myomectomy.

The study, conducted as a randomized, double-blinded multicenter research effort, spanned from August 2020 to October 2020. It involved 180 premenopausal women undergoing abdominal myomectomy at several prominent hospitals. These patients were divided into three groups: one receiving oxytocin, another receiving TA with ethamsylate, and a third receiving a placebo just before surgical incision.

The primary objective of this study was to assess the efficacy and safety profiles of these hemostatic drugs in reducing intraoperative blood loss, a critical concern in myomectomy due to the highly vascular nature of uterine fibroids.

The findings, however, yielded unexpected results. The study concluded that both oxytocin and TA with ethamsylate had no significant impact on lowering intraoperative blood loss compared to the placebo. The recorded blood loss figures for the three groups showed little variance, with p-values indicating non-significance.

Furthermore, the study observed non-significant trends in other key parameters such as operation time, intra/postoperative blood transfusion, hospital stay, postoperative fever, and wound infection. These findings suggest that these hemostatic drugs might not provide substantial benefits beyond what can be achieved with standard care.

The implications of this study are significant. It challenges the current practices of using hemostatic drugs during myomectomy, which has been a common approach to minimize bleeding. Moreover, it raises questions about the allocation of resources in healthcare settings, especially in regions with limited resources, where the cost-effectiveness of using these drugs could be questionable.

Further research with larger and more diverse cohorts is warranted to validate these findings and potentially identify subgroups of patients who may still benefit from these hemostatic drugs.

Reference:

Abdou, A. M., Eldesouky, E., Farag, E., Mohammed, A., Abdelaziz, D. F. M., Shaaban, A., Ellaban, M., Elhalim, A. E. M. A., Elsror, A. G. A., Marai, A. A. E., Abdelhamed, S. A., Bosilah, A. H., & Marie, H. (2023). Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial. In BMC Women’s Health (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12905-023-02549-z