Obstet Gynecol Sci.  2022 Sep;65(5):406-419. 10.5468/ogs.22115.

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

• Abu-Zaid A
• Baradwan S
• Badghish E
• AlSghan R
• Ghazi A
• Albouq B
• Khadawardi K
• AlNaim NF
• AlNaim LF
• Fodaneel M
• AbuAlsaud FS
• Jamjoom MZ
• Almubarki AA
• Alsehaimi SO
• Alabdrabalamir S
• Alomar O
• Al-Badawi IA
• Salem H

• KMID: 2533814
• DOI: http://doi.org/10.5468/ogs.22115

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.

Keyword

Tranexamic acid; Hysterectomy; Bleeding; Randomized controlled trial; Meta-analysis bleeding

Figure

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  Fig. 1 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for literature search. RCT, randomized controlled trial.

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  Fig. 2 The risk of bias summary and graph of the included studies.

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  Fig. 3 Meta-analysis of the efficacy endpoints: (A) mean estimated intraoperative blood loss, (B) mean postoperative hemoglobin level, (C) requirement rate for intraoperative hemostatic agents, and (D) requirement rate for postoperative blood transfusion. TXA, tranexamic acid; SD, standard deviation; CI, confidence interval; M–H, mantel-haenszel.

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  Fig. 4 Meta-analysis of the efficacy endpoints: (A) mean duration of surgery, and (B) mean duration of hospital stay. TXA, tranexamic acid; SD, standard deviation; CI, confidence interval.

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  Fig. 5 Meta-analysis of the safety endpoints (nausea and vomiting, diarrhea, and abdominal pain). TXA, tranexamic acid; M–H, mantelhaenszel; CI, confidence interval.

Reference

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