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
