Reducing Blood Loss During Abdominal Hysterectomy with Intravenous Versus Topical Tranexamic Acid: A Double-Blind Randomized Controlled Trial

Abstract

Objectives To assess the effect of intravenous versus topical tranexamic acid in reducing intraoperative and postoperative blood loss in women with abdominal hysterectomy. Materials and MethodsThe study was a randomized double-blind placebo-controlled trial, carried out in a tertiary university hospital in Egypt, from November 2015 to October 2017. A total of 129 women undergoing abdominal hysterectomy for benign etiology were randomly assigned to three groups: Group I [43 patients received 110 ml normal saline IV just before skin in scion], Group II [43 patients received 1 g tranexamic acid in 100 ml saline IV just before skin in scion], and Group III [43 patients received 2 g topical tranexamic acid applied intra-abdominal after hysterectomy]. The primary outcome was intraoperative, postoperative, and all blood loss estimation. Results Both Group II (IV tranexamic acid) and Group III (topical tranexamic acid application) showed great reduction in intraoperative and postoperative blood loss (blood in the intra-abdominal drain) compared with Group I (placebo group), (P = 0.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in groups II and III showed highly reduction compared with Group I (P = 0.0001, 0.0001). Conclusion Intravenous and topical tranexamic acid application is a safe and reliable method to help decrease blood loss during and after abdominal hysterectomy.

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Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review

“…This is in comparison to the Cochrane Review of Surgical Approach to Hysterectomy for benign disease, which reported the median range of estimated blood loss for abdominal hysterectomies to be 238 to 650 mL. Similarly, recently published randomized trials including patients undergoing abdominal hysterectomy for uterine myomas estimated the blood loss to be 466 § 205 mL and the median to be 480 mL (350 −700 mL) [189,190].…”

Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis

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“…Only five studies 50 , 52 , 57 , 59 , 67 considered mortality as an outcome. The duration of follow-up in these studies ranged from the hospital admission to 1 year.…”