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

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

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)

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