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Tranexamic acid does not decrease blood loss during myomectomy

15 Sep 2020

Tranexamic acid administrated intravenously in patients undergoing laparoscopic or robotic myomectomies does not appear to reduce blood loss.

Women with symptomatic fibroids thought to be at risk for large intraoperative blood loss who had at least one fibroid ≥10 cm, any intramural or broad ligament fibroid ≥6 cm, and/or at least five total fibroids based on preoperative imaging were randomized to receive a single intravenous bolus injection of tranexamic acid 15 mg/kg (intervention group) or an intravenous bolus injection of saline of equivalent volume (placebo group) 20 minutes before the initial surgical incision.

The investigators defined perioperative bleeding by measuring intraoperative estimated blood loss, change between pre- and postoperative haemoglobin, and frequency of blood transfusions. They calculated the estimated blood loss by combining the blood volume collected within the suction canister and the weight of used sponges.

Finally, the investigators compared the two groups in terms of age; body mass index (BMI); perioperative haemoglobin and haematocrit; perioperative blood loss; duration of surgery; blood transfusion requirements; and the number, total weight, and volume of myomas removed.

Sixty patients (30 per group) participated in the study between 1 March 2015 and 29 January 2018. Both groups had comparable age, BMI, baseline haemoglobin and/or haematocrit, number and total weight of myomas removed, and myoma size. Of the participants, 32 (53 percent) patients had laparoscopic myomectomy, 24 (40 percent) had robotic myomectomy, and four (7 percent) had laparotomy.

The median estimated blood loss was 200 and 240 mL for the tranexamic acid and placebo group, respectively (p=0.88). No between-group difference was observed in the median duration of surgery (165 vs 164 min; p=0.64) or change in perioperative haemoglobin (1.00 vs 1.1 g/dL; p=0.64).

Blood transfusions were not required among patients in the tranexamic acid group. On the other hand, four patients (13.3 percent) in the placebo group needed blood transfusions (p=0.11).

“Myomectomy is associated with a significant risk of haemorrhage,” the investigators said. “Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery.”

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