Does Tranexamic Acid Reduce Blood Loss During Myomectomy?

BACKGROUND AND PURPOSE:

  • Fusca et al. (Journal of Obstetrics and Gynaecology Canada, 2018) assessed the effectiveness of tranexamic acid (TXA) in reducing perioperative blood loss during myomectomy

METHODS:

  • Systematic review and meta-analysis
    • Women of reproductive age with uterine fibroids undergoing myomectomy (abdominal, laparoscopic, robotic, or hysteroscopic)
  • Included RCTs that assessed
    • TXA vs
    • Comparator
      • Placebo | No treatment | Another active comparator
  • Primary outcomes
    • Perioperative blood loss or
    • Transfusion

RESULTS:

  • 4 RCTS | 313 women undergoing myomectomy
    • 3 studies: Abdominal myomectomy
    • 1 study: Hysteroscopic myomectomy
  • Compared to placebo or no intervention, TXA significantly reduced
    •  Intraoperative blood loss (abdominal): Mean difference 213.1 mL (95% CI, -242.4 to -183.7)
      • Above results from abdominal hysterectomy because no intraoperative blood loss was reported for the 1 hysteroscopic myomectomy
    • Postoperative blood loss (abdominal): Mean difference 56.3 mL (95% CI, -67.8 to -44.8)
  • Blood transfusion
    • No significant differences between groups in blood transfusion requirement
    • Relative risk 0.58 (95% CI, 0.33-1.00)
  • Hysteroscopic myomectomy
    • TXA not associated with improved outcomes for reduced postoperative hemoglobin levels compared with oxytocin
      • 10.18 vs 11.13 g/dL (p<0.001)

CONCLUSION:

  • TXA reduces perioperative blood loss in women undergoing abdominal myomectomy but no impact was seen in women undergoing hysteroscopic myomectomy
  • Studies looking at TXA for laparoscopic or robotic myomectomy were not found
    • Authors note that blood loss is significantly lower with minimally invasive surgical myomectomy approach
    • Benefit of TXA may therefore be limited in minimally invasive surgery for myomectomy

Learn More – Primary Sources:

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