Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials

Abstract

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy and safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy for benign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed for risk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervals in a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two and three studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirement for postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantly reduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobin level was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequency of self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhea rate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolic events, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivity analyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions, prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative blood loss and related morbidities.

Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial

“…TXA has also been proven to be effective to reduce blood loss in other gynaecological procedures. In a systemic review and meta-analysis of randomized controlled trial, Abu-Zaid et al reported that TXA is effective in reducing intraoperative blood loss, requirement for postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents among patients undergoing hysterectomy [ 26 ]. TXA has also been proven to be effective and safe in reducing postpartum hemorrhage among parturients.…”

Determining Efficacy of Tranexamic Acid in Reducing Post Partum Haemorrhage in Elective Cesarean Section Patients Evaluating in Referance to Fall in Haemoglobin

“…TA has recently been shown to reduce haemorrhage in gynaecology illnesses like menorrhagia, hysterectomy, and myomectomy. Numerous researches examined the use of TA administration in caesarean section and found it to be effective (3,4).…”