The effect of iv tranexamic acid on blood loss during myomectomy

Year 2022, Volume: 39 Issue: 3, 616 - 619, 30.08.2022

Üzeyir Kalkan Mehmet Ölçenoğlu Kadir Bakay

Abstract

Regarding myomas presenting with clinical symptoms the rate is about 33% according to literature with the remaining population being incidentally detected. These symptoms may range from variable amounts of uterine bleeding to clinically significant anemia, persistant pelvic pressure, pain, urinary disfunction and infertility (1-7).

Symptomatic myomas should be treated or followed according to the individual but when concerning treatment options, there is a wide spectrum available from hormonal or nonhormonal medical alternatives to surgical procedures (8). The suitable treatment method is usually determined by considering several factors such as, patient age, number of myomas, fertility preference and the symptoms of the patient. Myomectomy is the most common treatment method among women who want to remain fertile and/or to protect their uterus. Approximately 1-4% of myomectomy operations end up with hysterectomy due to uncontrollable bleeding (9). Many different methods are used in order to reduce the incidence of uncontrollable bleeding and minimize blood loss (10,11).

The use of intraoperative iv tranexamic acid (TXA) is more common than ever in recent years. The fundamental mechanism of action is to reduce bleeding by inhibiting plasminogen activity (12). There are studies in literature suggesting that the use of TXA reduces blood loss during cardiovascular surgery, orthopedic operations, and organ transplantation (13-15).

In this study, we have examined the effect of intraoperative intravenous tranexamic acid on blood loss on type 3-6 myomas during myomectomy according to FIGO grading (16) and its postoperative results. Our secondary purpose was to determine whether TXA use changes the need for blood products.

Keywords

uterine leiomyoma, myomectomy, tranexamic acid

References

• 1.Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003; 188:100-107.
• 2. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health 2014; 6:95–114.
• 3. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med 1996; 41:483–90.
• 4. Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women’s Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol 1994; 83:566–72.
• 5. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12:6.
• 6. Lippman SA, Warner M, Samuels S, Olive D, Vercellini P, Eskenazi B. Uterine fibroids and gynecologic pain symptoms in a population- based study. Fertil Steril 2003; 80:1488–94.
• 7. Cook H, Ezzati M, Segars JH, McCarthy K. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol 2010; 62:225–36.
• 8. Boosz AS, Reimer P, Matzko M, Römer T, Müller A. The conservative and interventional treatment of fibroids. Dtsch Arztebl Int. 2014 Dec 22;111(51-52):877-83. doi: 10.3238/arztebl.2014.0877. PMID: 25597366; PMCID: PMC4298239.
• 9. Donnez J, Dolmans MM. Uterine fibroid management: from the present the future. Hum report Update. 2016;22(6):665-686.
• 10. Kongnyuy EJ, Wiysonge CS. Interventions to reduce hemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD005355. DOI: 10.1002/14651858.CD005355.pub5. Accessed 13 August 2021.
• 11.Koh MBC, Hunt BJ. The management of perioperative bleeding. Blood Rev 2003; 17:179–85.
• 12.Goobie SM. Tranexamic acid: still far to go. Br J Anaesth 2017; 15:134-9
• 13. Wang C, Xu Gj, Han Z, et al. Topical application of tranexamic acid in primary total hip arthroplasty: a systemic review and meta-analysis. Int J Surgery2015; 15:134-9.
• 14. Takagi H, Ando T, Umumeto T, et al. Seizures associated with tranexamic acid for cardiac surgery: a meta-analysis of randomized and non-randomized studies. J Cardiovasc Surg (Torino) 2017; Mar 6. doi: 10.23736/S0021-9509.17.09877-9
• 15.Massicotte L, Denault AY, Beaulieu D, et al. Aprotinin versus tranexamic acid during liver transplantation: impact on blood product requirements and survival. Transplantation 2011; 91:1273-8
• 16.Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. doi: 10.1016/j.ijgo.2010.11.011. Epub 2011 Feb 22. PMID: 21345435.
• 17.Tinelli A, Malvasi A, Rahimi S, Negro R, Cavallotti C, Vergara D, Vittori G, Mettler L. Myoma pseudocapsule: a distinct endocrino-anatomical entity in gynecological surgery. Gynecol Endocrinol. 2009 Oct;25(10):661-7. doi: 10.1080/09513590903015502. PMID: 19526398.
• 18. DunnCJ, GoaKL.Tranexamicacid. Areviewofitsuseinsurgeryand other indications. Drugs 1999;57(6):1005–32.
• 19.Opoku-Anane J, Vargas MV, Marfori CQ, Moawad G, Maasen MS, Robinson JK. Intraoperative tranexamic acid to decrease blood loss during myomectomy: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2020 Sep;223(3): 413.e1-413.e7. doi: 10.1016/j.ajog.2020.02.019. Epub 2020 Mar 28. PMID: 32229194.
• 20. Bhagavath B, Lindheim SR. Options for controlling blood loss during myomectomy. Fertil Steril. 2019 May;111(5):894. doi: 10.1016/j.fertnstert.2019.03.011. PMID: 31029243.
• 21. Caglar GS, Tasci Y, Kayikcioglu F, Haberal A. Intravenous tranexamic acid use in myomectomy: a prospective randomized double-blind placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2008 Apr;137(2):227-31. doi: 10.1016/j.ejogrb.2007.04.003. Epub 2007 May 11. PMID: 17499419.
• 22. Wang, Dongdong MMa; Wang, Lixia MDb; Wang, Yifei MDb; Lin, Xinyan MMb The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: A meta-analysis of randomized controlled trials * Retracted, Medicine: June 2017 - Volume 96 - Issue 23 - p e7072 doi: 10.1097/MD.0000000000007072