Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials

Baradwan, Saeed; Hafidh, Bandr; Latifah, Hassan M; Gari, Abdulrahim; Sabban, Hussein; Abduljabbar, Hanin Hassan; Tawfiq, Afaf; Hakeem, Ghaidaa; Alkaff, Alya; AlSghan, Rayan; Alshahrani, Majed Saeed; Badghish, Ehab; Abu‐Zaid, Ahmed

doi:10.1016/j.ejogrb.2022.07.004

Cited by 4 publications

(8 citation statements)

References 45 publications

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“…This supports the effect of the drug on blood loss by promoting clot formation and inhibiting clot dissolution. Baradwan et al, Shaaban et al, and Fusca et al observed similar findings in their meta-analysis and systemic review of RCTs, where significant reduction of blood loss was recorded following the use of tranexamic acid during myomectomy [ 14 , 20 , 24 ]. However, this differs from the finding in the United States clinical trial where TXA was found to insignificantly reduced blood loss by mean volume of 63 ml, and there was no difference in blood transfusion rate for patients in both arms of the study [ 13 ].…”

Section: Discussionmentioning

confidence: 61%

“…However, further studies were suggested to affirm this finding [ 13 ]. In another RCT comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients), TXA was found to reduce the mean intraoperative blood loss by average value of 224.34 ml (95% CI [-303.06, -145.61], P < 0.001), and mean postoperative blood loss and mean total blood loss were significantly reduced in favor of the prophylactic TXA [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial

Olaleye,

Adebayo,

Eze

et al. 2024

International Journal of Reproductive Medicine

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Background. 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. Objective. To assess the efficacy of tranexamic acid in reducing myomectomy-associated blood loss. Materials and Methods. This is a prospective double-blinded randomized trial 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. The data was processed using Epi Info software (7.2.1, CDC, Atlanta, Georgia). The relationships between categorical data were analyzed using X2 and Student’s t-test to determine relationships between continuous variables, with a P value of 0.05 considered statistically significant, and correlation coefficients were calculated using Pearson’s formula, and probability of 0.05 was set for statistical significance. Results. 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. Conclusion. The use of tranexamic acid during myomectomy reduced intraoperative and postoperative blood loss. It is also associated with decreased hospital stay. This trial is registered with NCT04560465.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial

Olaleye,

Adebayo,

Eze

et al. 2024

International Journal of Reproductive Medicine

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“…Overall, the present meta-analysis does not seem to recommend the use of ascorbic acid as an antihemorrhagic agent among patients undergoing myomectomy. Evidence from previous meta-analyses showed the clinical efficacy of several antihemorrhagic agents, such as oxytocin/carbetocin [ 24 ], tranexamic acid [ 25 ], and vasopressin [ 6 ], during myomectomy. Hence, future investigations may include a direct comparison between ascorbic acid and other active comparators (e.g., oxytocin/carbetocin, tranexamic acid, and vasopressin).…”

Section: Reviewmentioning

confidence: 99%

Ascorbic Acid for Prevention of Intraoperative Blood Loss and Related Complications During Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abu‐Zaid¹,

Alrashidi²,

Almouh³

et al. 2022

Cureus

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Leiomyomas are inherently well-vascularized neoplasms; thus, they are very vulnerable to bleedingassociated complications during myomectomy. Ascorbic acid has well-established functions in tissue healing and the prevention of bleeding tendencies. Several randomized controlled trials (RCTs) have explored the antihemorrhagic utility of ascorbic acid administration during myomectomy. This research aimed to systematically and meta-analytically summarize the clinical antihemorrhagic efficacy of ascorbic acid (i.e., the intervention arm) versus placebo/no treatment (i.e., the control arm) during myomectomy. We electronically searched six sources, i.e., PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. Our search was from inception until October 2022. We used the Cochrane Risk of Bias Scale (version 2) to assess the quality of the included studies. We summarized the effect sizes as the mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in a fixedeffects or random-effects model. Overall, three RCTs met the inclusion criteria, comprising a total of 193 patients: 99 patients were allocated to the ascorbic acid arm, whereas 94 patients were allocated to the control arm. The overall study quality was "low" and "some concerns" risk of bias in two and one RCT(s), respectively. There was no significant difference between the ascorbic acid and control arms regarding the mean intraoperative blood loss (n=2 RCTs, MD = −190.29 ml, 95% CI [−626.62, 246.05], p=0.39) and mean change in hemoglobin level (n=3 RCTs, MD = −0.26 mg/dl, 95% CI [−0.56, 0.04], p=0.09), respectively. Conversely, the ascorbic acid arm had statistically significant reductions in the mean operative time (n=3 RCTs, MD = −24.10 min, 95% CI [−30.67, −17.53], p<0.001) and the rate of blood transfusion (n=3 RCTs, RR=0.36, 95% CI [0.15, 0.87], p=0.02) compared with the control arm. No serious adverse events related to ascorbic acid were identified. In conclusion, ascorbic acid administration was associated with several beneficial effects, including reductions in mean operative time and rate of blood transfusion, but without affecting the mean intraoperative blood loss and mean change in hemoglobin level. In view of the limitations of the present meta-analysis, the use of ascorbic acid as an antihemorrhagic additive among patients undergoing myomectomy is not strongly recommended.

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“…Furthermore, life-threatening hemodynamic instability, shock, coagulopathy, and mortality are potential consequences if the bleeding is not effectively controlled following myomectomy. Thus, measures to minimize bleeding and associated morbidities are essential to lower morbidity and mortality during myomectomy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Few trials have looked at the effectiveness of various perioperative pharmacologic treatments, such as oxytocin, tranexamic acid (TA), and ethamsylate, to reduce blood loss and associated morbidities during myomectomy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial

Abdou,

Eldesouky,

Farag

et al. 2023

BMC Women's Health

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Objective Myomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy. Methods This randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision. Results In 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1). Conclusion Oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates. Trial registration The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.

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Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials

Cited by 4 publications

References 45 publications

Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial

Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial

Ascorbic Acid for Prevention of Intraoperative Blood Loss and Related Complications During Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial

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