Comparison of the Intraoperative Outcomes of Intrauterine Instillation of Epsilon-Aminocaproic Acid and Intravenous Oxytocin in Hysteroscopy Surgeries

Intrauterine Instillation of Tranexamic Acid in Hysteroscopic Myomectomy: A Double-Blind, Placebo-Controlled, Parallel-Group Randomized Clinical Trial

“…The effect of myomas on the endometrium is global and is transmitted through producing abundant cytokines and growth factors that have a profound impact on adjacent tissues rather than entirely through physical and mechanical disruption [28]. Transforming growth factor b (TGF-b) secreted by myomas simultaneously affects endometrial receptivity and menstrual cycle regulation; TGF-b3 alters the production of plasminogen activator inhibitor-1, antithrombin 3, and thrombomodulin in the endometrium, resulting in heavy menstrual bleeding [29], so TXA can interfere with the increased plasminogen activator levels found in the endometrium of women with submucous myomas [30].…”

“…The success of hysteroscopic surgical procedures is strongly dependent on constant surgical field visibility, so implementing the best strategy to decrease intraoperative blood loss remains a research priority. Injecting a dilute vasopressin solution directly into the submucosal myoma [26,31], intracervical administration of vasopressin [32], gonadotropin-releasing hormone agonist, danazol [2,33], epsilon-aminocaproic acid (EACA), or oxytocin [30] all have different mechanisms of actions, variable effects, costs, and side effects.…”