The efficacy of tranexamic acid for decreasing blood loss in open myomectomy

Sara A. Mahjer Alkhalifah; Sajida A. R. Hassan; Marwah S. M. Almansor

doi:10.31893/multiscience.2024150

Keywords:

Abstract

Uterine fibroids are the most prominent benign tumor in females. Recently, attention has focused on the use of tranexamic acid to reduce blood loss if given prophylactically at myomectomy. We conducted this study to evaluate the efficacy and safety of perioperative tranexamic acid in blood loss reduction in many patients with uterine fibroids undergoing myomectomy et al Basrah maternity and children’s hospital in Basrah. The study was conducted at Basrah maternity and child hospital for the period from the 1st of January 2020 till the 1st of January 2023. It includes 98 (48 control who received no medication before the surgery and 50 cases patients who received IV 1 g tranexamic acid at the skin incision) ladies who planned to undergo open myomectomy. The duration of surgery was calculated in minutes, Intraoperative, postoperative, and total blood loss was measured. Abdominal pain was the commonest presenting symptom of fibroid in both case and control group (56.0% and 52.1%, respectively) and followed by AUB then the infertility. Regarding the intraoperative, postoperative, and total blood loss there’s a significant significant difference between case and control group. The operation time and hospital stay were significantly less among case group who received IV tranexamic acid. Tranexamic acid is a safe drug to reduce hemorrhage in women with fibroid subjected to open myomectomy and it has no major adverse effects.
References
1. Bulun, S. E. (2013). Uterine Fibroids. New England Journal of Medicine, 369(14), 1344–1355. https://doi.org/10.1056/nejmra1209993
2. Caglar, G. S., Tasci, Y., Kayikcioglu, F., & Haberal, A. (2008). Intravenous tranexamic acid use in myomectomy: A prospective randomized double-blind placebo controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 137(2), 227–231. https://doi.org/10.1016/j.ejogrb.2007.04.003
3. Cheng, Z., Yang, W., Luo, N., Ma, L., & Dai, H. (2018). The changes of surgical treatment for symptomatic uterine myomas in the past 15 Years. Gynecology and Minimally Invasive Therapy, 7(1), 10. https://doi.org/10.4103/gmit.gmit_11_17
4. Conforti, A., Mollo, A., Alviggi, C., Tsimpanakos, I., Strina, I., Magos, A., & De Placido, G. (2015). Techniques to reduce blood loss during open myomectomy: a qualitative review of literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 192, 90–95. https://doi.org/10.1016/j.ejogrb.2015.05.027
5. Day Baird, D., Dunson, D. B., Hill, M. C., Cousins, D., & Schectman, J. M. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1), 100–107. https://doi.org/10.1067/mob.2003.99
6. Flake, G. P., Andersen, J., & Dixon, D. (2003). Etiology and pathogenesis of uterine leiomyomas: a review. Environmental Health Perspectives, 111(8), 1037–1054. https://doi.org/10.1289/ehp.5787
7. Follrud, C., Lethagen, S., & Berntorp, E. (2001). No Increased Risk of Venous Thrombosis in Women Taking Tranexamic Acid. Thrombosis and Haemostasis, 86(08), 714–715. https://doi.org/10.1055/s-0037-1616122
8. Fusca, L., Perelman, I., Fergusson, D., Boutet, M., & Chen, I. (2019). The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis. Journal of Obstetrics and Gynaecology Canada, 41(8), 1185-1192.e1. https://doi.org/10.1016/j.jogc.2018.04.007
9. Gai, M., Wu, L., Su, Q., & Tatsumoto, K. (2004). Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 112(2), 154–157. https://doi.org/10.1016/s0301-2115(03)00287-2
10. Kongnyuy, E. J., & Wiysonge, C. S. (2014). Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews, 8. https://doi.org/10.1002/14651858.cd005355.pub5
11. Lakshmi, S. D. (2016). Role of Prophylactic Tranexamic Acid in Reducing Blood Loss during Elective Caesarean Section: A Randomized Controlled Stud y. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH, 10(12). https://doi.org/10.7860/jcdr/2016/21702.9050
12. Marsh, E. E., & Bulun, S. E. (2006). Steroid Hormones and Leiomyomas. Obstetrics and Gynecology Clinics of North America, 33(1), 59–67. https://doi.org/10.1016/j.ogc.2005.12.001
13. Neelanjana Mukhopadhaya, Chaminda De Silva, & Manyonda, I. (2008). Conventional myomectomy. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(4), 677–705. https://doi.org/10.1016/j.bpobgyn.2008.01.012
14. Shaaban, M. M., Ahmed, M. F., Farhan, R. E., & Dardeer, H. H. (2016). Efficacy of Tranexamic Acid on Myomectomy-Associated Blood Loss in Patients With Multiple Myomas: A Randomized Controlled Clinical Trial. Reproductive Sciences, 23(7), 908–912. https://doi.org/10.1177/1933719115623646
15. The CRASH-3 trial collaborators. (2019). Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet, 394(10210). https://doi.org/10.1016/s0140-6736(19)32233-0
16. Wang, D., Wang, L., Wang, Y., & Lin, X. (2017). The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: a meta-analysis of randomized controlled trials. Medicine, 96(23), e7072. https://doi.org/10.1097/md.0000000000007072
17. WHO. (2017). Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage 1 Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage Highlights and Key Messages from the World Health Organization’s 2017 Global Recommendation. https://iris.who.int/bitstream/handle/10665/259379/WHO-RHR-17.21-eng.pdf
18. Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health, 12(6), 6. https://doi.org/10.1186/1472-6874-12-6

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How to cite

Alkhalifah, S. A. M., Hassan, S. A. R., & Almansor, M. S. M. (2024). The efficacy of tranexamic acid for decreasing blood loss in open myomectomy. Multidisciplinary Science Journal, 6(8), 2024150. https://doi.org/10.31893/multiscience.2024150

[1] Bulun, S. E. (2013). Uterine Fibroids. New England Journal of Medicine, 369(14), 1344–1355. https://doi.org/10.1056/nejmra1209993

[2] Caglar, G. S., Tasci, Y., Kayikcioglu, F., & Haberal, A. (2008). Intravenous tranexamic acid use in myomectomy: A prospective randomized double-blind placebo controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 137(2), 227–231. https://doi.org/10.1016/j.ejogrb.2007.04.003

[3] Cheng, Z., Yang, W., Luo, N., Ma, L., & Dai, H. (2018). The changes of surgical treatment for symptomatic uterine myomas in the past 15 Years. Gynecology and Minimally Invasive Therapy, 7(1), 10. https://doi.org/10.4103/gmit.gmit_11_17

[4] Conforti, A., Mollo, A., Alviggi, C., Tsimpanakos, I., Strina, I., Magos, A., & De Placido, G. (2015). Techniques to reduce blood loss during open myomectomy: a qualitative review of literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 192, 90–95. https://doi.org/10.1016/j.ejogrb.2015.05.027

[5] Day Baird, D., Dunson, D. B., Hill, M. C., Cousins, D., & Schectman, J. M. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1), 100–107. https://doi.org/10.1067/mob.2003.99

[6] Flake, G. P., Andersen, J., & Dixon, D. (2003). Etiology and pathogenesis of uterine leiomyomas: a review. Environmental Health Perspectives, 111(8), 1037–1054. https://doi.org/10.1289/ehp.5787

[7] Follrud, C., Lethagen, S., & Berntorp, E. (2001). No Increased Risk of Venous Thrombosis in Women Taking Tranexamic Acid. Thrombosis and Haemostasis, 86(08), 714–715. https://doi.org/10.1055/s-0037-1616122

[8] Fusca, L., Perelman, I., Fergusson, D., Boutet, M., & Chen, I. (2019). The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis. Journal of Obstetrics and Gynaecology Canada, 41(8), 1185-1192.e1. https://doi.org/10.1016/j.jogc.2018.04.007

[9] Gai, M., Wu, L., Su, Q., & Tatsumoto, K. (2004). Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 112(2), 154–157. https://doi.org/10.1016/s0301-2115(03)00287-2

[10] Kongnyuy, E. J., & Wiysonge, C. S. (2014). Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews, 8. https://doi.org/10.1002/14651858.cd005355.pub5

[11] Lakshmi, S. D. (2016). Role of Prophylactic Tranexamic Acid in Reducing Blood Loss during Elective Caesarean Section: A Randomized Controlled Stud y. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH, 10(12). https://doi.org/10.7860/jcdr/2016/21702.9050

[12] Marsh, E. E., & Bulun, S. E. (2006). Steroid Hormones and Leiomyomas. Obstetrics and Gynecology Clinics of North America, 33(1), 59–67. https://doi.org/10.1016/j.ogc.2005.12.001

[13] Neelanjana Mukhopadhaya, Chaminda De Silva, & Manyonda, I. (2008). Conventional myomectomy. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(4), 677–705. https://doi.org/10.1016/j.bpobgyn.2008.01.012

[14] Shaaban, M. M., Ahmed, M. F., Farhan, R. E., & Dardeer, H. H. (2016). Efficacy of Tranexamic Acid on Myomectomy-Associated Blood Loss in Patients With Multiple Myomas: A Randomized Controlled Clinical Trial. Reproductive Sciences, 23(7), 908–912. https://doi.org/10.1177/1933719115623646

[15] The CRASH-3 trial collaborators. (2019). Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet, 394(10210). https://doi.org/10.1016/s0140-6736(19)32233-0

[16] Wang, D., Wang, L., Wang, Y., & Lin, X. (2017). The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: a meta-analysis of randomized controlled trials. Medicine, 96(23), e7072. https://doi.org/10.1097/md.0000000000007072

[17] WHO. (2017). Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage 1 Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage Highlights and Key Messages from the World Health Organization’s 2017 Global Recommendation. https://iris.who.int/bitstream/handle/10665/259379/WHO-RHR-17.21-eng.pdf

[18] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health, 12(6), 6. https://doi.org/10.1186/1472-6874-12-6

Abstract

References

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