The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis

Fusca, Laura; Perelman, Iris; Fergusson, Dean; Boutet, Mish; Chen, Innie

doi:10.1016/j.jogc.2018.04.007

Cited by 21 publications

(14 citation statements)

References 20 publications

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“…In agreement with our findings, a recent meta-analysis by Fusca et al (12) reported that TXA effectively reduces the intraoperative and postoperative blood loss during myomectomy, as well as the need for blood transfusion. Another meta-analysis showed that intravenous TXA significantly reduced the total blood loss in OM (48).…”

Section: Discussionsupporting

confidence: 93%

“…In recent years, a growing body of literature has investigated the efficacy of various perioperative pharmacological interventions to reduce blood loss during myomectomy. Uterotonics (such as misoprostol and oxytocin), antifibrinolytic agents, and vasoconstrictive agents were reported to significantly reduce blood loss and the need for blood transfusion among women undergoing myomectomy (11,12). However, the current evidence remains inconclusive regarding the best perioperative pharmacological option for reducing bleeding during myomectomy.…”

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confidence: 99%

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Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis

Samy

Raslan

Talaat

et al. 2020

Fertility and Sterility

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Objective: To synthesize evidence on the most effective pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy. Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patients: Trials assessing efficacy of pharmacological interventions during different types of myomectomy. Interventions: Misoprostol, oxytocin, vasopressin, tranexamic acid (TXA), epinephrine, or ascorbic acid. Main Outcome Measures: Intraoperative blood loss and need for blood transfusion. Results: The present review included 26 randomized control trials (RCTs) (N ¼ 1627). For minimally invasive procedures (9 RCTs; 474 patients), network meta-analysis showed that oxytocin (mean difference [MD] À175.5 mL, 95% confidence interval [CI] À30.1.07, À49.93), ornipressin (MD À149.6 mL, 95% CI À 178.22, À120.98), misoprostol, bupivacaine plus epinephrine, and vasopressin were effective in reducing myomectomy blood loss, but the evidence is of low quality. Ranking score of treatments included in subgroup analysis of minimally invasive myomectomy showed that oxytocin ranked first in reducing blood loss, followed by ornipressin. For open myomectomy (17 RCTs; 1,153 patients), network meta-analysis showed that vasopressin plus misoprostol (MD À652.97 mL, 95% CI À 1113.69, À174.26), oxytocin, TXA, and misoprostol were effective; however, the evidence is of low quality. Vasopressin plus misoprostol ranked first in reducing blood loss during open myomectomy (P ¼ .97). Conclusion:There is low-quality evidence to support uterotonics, especially oxytocin, and peripheral vasoconstrictors as effective options in reducing blood loss and need for blood transfusion during minimally invasive myomectomy. Oxytocin is the most effective intervention in minimally invasive myomectomy. For open myomectomy, a combination of uterotonics and peripheral vasoconstrictors is needed to effectively reduce blood loss. (Fertil Steril Ò 2020;113:224-33. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis

Samy

Raslan

Talaat

et al. 2020

Fertility and Sterility

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“…For antifibrinolytic SSPLT, we formulated tranexamic acid (TA)-containing thermosensitive PEGylated DPPC and DPPC:lysoPC liposomes [ 16 ] that are envisaged to target to laser-induced thrombi and release TA upon a mild hyperthermic stimulus [ 17 ] using near-infrared light [ 9 , 11 , 14 ]. TA is a potent antifibrinolytic drug used clinically to deter heavy bleeding during e.g., surgery [ 18 , 19 ] through its inhibition of the enzyme (plasmin) responsible for thrombolysis [ 20 ]. To date our group has demonstrated that non-encapsulated TA reduces laser-induced thrombus breakdown in hamsters (manuscript in preparation).…”

Section: Introductionmentioning

confidence: 99%

In Vivo Assessment of Thermosensitive Liposomes for the Treatment of Port Wine Stains by Antifibrinolytic Site-Specific Pharmaco-Laser Therapy

Raath

Khakpour

et al. 2020

Pharmaceutics

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Antifibrinolytic site-specific pharmaco-laser therapy (SSPLT) is an experimental treatment modality for refractory port wine stains (PWS). Conceptually, antifibrinolytic drugs encapsulated in thermosensitive liposomes are delivered to thrombi that form in semi-photocoagulated PWS blood vessels after conventional laser treatment. Local release of antifibrinolytics is induced by mild hyperthermia, resulting in hyperthrombosis and complete occlusion of the target blood vessel (clinical endpoint). In this study, 20 thermosensitive liposomal formulations containing tranexamic acid (TA) were assayed for physicochemical properties, TA:lipid ratio, encapsulation efficiency, and endovesicular TA concentration. Two candidate formulations (DPPC:DSPE-PEG, DPPC:MPPC:DSPE-PEG) were selected based on optimal properties and analyzed for heat-induced TA release at body temperature (T), phase transition temperature (Tm), and at T > Tm. The effect of plasma on liposomal stability at 37 °C was determined, and the association of liposomes with platelets was examined by flow cytometry. The accumulation of PEGylated phosphocholine liposomes in laser-induced thrombi was investigated in a hamster dorsal skinfold model and intravital fluorescence microscopy. Both formulations did not release TA at 37 °C. Near-complete TA release was achieved at Tm within 2.0–2.5 min of heating, which was accelerated at T > Tm. Plasma exerted a stabilizing effect on both formulations. Liposomes showed mild association with platelets. Despite positive in vitro results, fluorescently labeled liposomes did not sufficiently accumulate in laser-induced thrombi in hamsters to warrant their use in antifibrinolytic SSPLT, which can be solved by coupling thrombus-targeting ligands to the liposomes.

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“…In the context of laparotomy, such as ours, because of the size and number of myomas, myomectomy is most often associated with a high rate of perioperative blood transfusions due to intraoperative hemorrhage [11,12]. Given the elevated risk of transfusion for this procedure and the potential serious adverse consequences of transfusion, medical interventions to reduce blood loss during myomectomy have the potential to prevent transfusion and its associated risks.…”

Section: Discussionmentioning

confidence: 99%

Laparotomy Myomectomy: Epidemiology, Indications and Prognosis at Loandjili General Hospital (Republic of Congo)

Emery¹,

César²,

Jostin³

et al. 2019

JGO

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To describe the epidemiological profile of patients, list myomectomy indications and report their prognosis at Loandjili General Hospital. A descriptive cross-sectional study conducted from 1 January 2016 to 31 December 2018 in the Gynecology Department of Loandjili General Hospital, including exhaustively all patients operated for myomectomy. The variables studied were pre (age, gestity, parity, indication), per (myoma measures, blood loss, intraoperative transfusion, complications and peroperative incidents) and postoperatively (hospital stay). Ninety-two patients had been received for surgical management of uterine fibroids out of a total of 1,455 gynecological procedures or 6.3%. The median age was 36.5 years [range 27 -44] with a peak in the 36 to 40 age group (37%). The median gestity and parity were respectively 2 [range 0 -12] and 1 [range 0 -7]. More than half of the patients were nulliparous (51.1%). In 71.7% of cases (n = 66), myomectomy was performed in a context of desire for maternity. Indications for myomectomy were hemorrhage (46.7%), large uterus above the umbilicus (37%) and pelvic pain (16.3%). The polymyomectomy was performed in 64.1% of the cases (n = 59) with nuclei of size varying between 2 and 20 cm. The morbidity was marked on the one hand by anemia (n = 14 or 14%) secondary to an intraoperative haemorrhage which resulted in two cases in performing a hemostatic hysterectomy and in the other by rupture of the uterine cavity. Postoperative blood loss was estimated at 200 to 1400 ml, resulting in more than half of the patients receiving blood transfusions (58%). Myomectomy by laparotomy is often accompanied by significant blood spoliation thus increasing the postoperative morbidity. Techniques that minimize intraoperative blood loss should be used for laparotomy myomectomy.

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The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis

Cited by 21 publications

References 20 publications

Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis

Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis

In Vivo Assessment of Thermosensitive Liposomes for the Treatment of Port Wine Stains by Antifibrinolytic Site-Specific Pharmaco-Laser Therapy

Laparotomy Myomectomy: Epidemiology, Indications and Prognosis at Loandjili General Hospital (Republic of Congo)

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