Use of tranexamic acid in bleeding control of transabdominal and transvaginal hysterectomy

Bahadori, Azadeh; Hirmanpour, Anahita; Bahadoran, Ensiyeh

Use of tranexamic acid in bleeding control of transabdominal and transvaginal hysterectomy

Document Type : Original Article

Authors

¹ Department of Anesthesiology, Shahrekord University of Medical Sciences, Shahrekord, Iran

² Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Hysterectomy is one of the most common gynecology surgeries. This study aimed to compare perioperative bleeding in transabdominal and transvaginal hysterectomy. Materials and Methods: This prospective, double-blind, randomized, controlled clinical trial was performed on 80 patients undergoing hysterectomy referred to Shahid Beheshti Hospital, Isfahan, Iran. Patients were divided into two groups of 40; the first group (T) received 1 g intravenous tranexamic acid (TXA) for 20 min preoperatively. The second group (S) received 10 cc normal saline as placebo. Blood samples were taken before and 12 h after surgery for assessment of hemoglobin, hematocrit, and platelet count, the prothrombin time, activated partial thromboplastin time, and serum creatinine as well as volume of blood transfusion. Results: There were no significant differences between the two groups in heart rate, diastolic blood pressure (BP), systolic BP, and mean arterial pressure before, during, and after surgery (P > 0.05). There was no significant difference in blood variables before and after surgery (P > 0.05) except the platelet count that was in the normal range in both groups after surgery (P = 0.022). The mean volume of blood transfused in the case group was significantly lower than the control group during surgery (P = 0.008) and 12 h after surgery (P = 0.01). Conclusion: The prophylactic administration of TXA results in a significant reduction in need for blood transfusion and the duration of surgery. Given the lower risks of using TXA compared to the other drugs, it is recommended in hysterectomy to control bleeding.

Keywords

References

1.	Limperger V, Langer F, Mesters R, Trappe RU, Nowak-Göttl U. Perioperative management of antithrombotic therapy in the periprocedural period of patients undergoing hysterectomy. In: Hysterectomy. New York: Springer; 2018. p. 299-305.
2.	Sallam HF, Shady NW. Reducing blood loss during abdominal hysterectomy with intravenous versus topical tranexamic acid: A double-blind randomized controlled trial. J Obstet Gynecol India 2018;69:1-7.
3.	Topsoee MF, Bergholt T, Ravn P, Schouenborg L, Moeller C, Ottesen B, et al. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy-a double-blinded randomized placebo-controlled trial. Am J Obstet Gynecol 2016;215:72.e1-8.
4.	Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985;29:236-61.
5.	Godier A, Hunt BJ. Aprotinin as an alternative to tranexamic acid in cardiac surgery – Is this where we started from? Anaesth Crit Care Pain Med 2017;36:79-81.
6.	Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 2017;376:136-48.
7.	Winter SF, Santaguida C, Wong J, Fehlings MG. Systemic and topical use of tranexamic acid in spinal surgery: A systematic review. Global Spine J 2016;6:284-95.
8.	Murphy GR, Glass GE, Jain A. The efficacy and safety of tranexamic acid in cranio-maxillofacial and plastic surgery. J Craniofac Surg 2016;27:374-9.
9.	Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics 2016;39:119-30.
10.	Ergun B, Bastu E, Ozsurmeli M, Celik C. Tranexamic acid: A potential adjunct to resectoscopic endometrial ablation. Int Surg 2012;97:310-4.
11.	Ngichabe S, Obura T, Stones W. Intravenous tranexamic acid as an adjunct haemostat to ornipressin during open myomectomy. A randomized double blind placebo controlled trial. Ann Surg Innov Res 2015;9:10.
12.	Sallam HF, Shady NW. Reducing blood loss during abdominal hysterectomy with intravenous versus topical tranexamic acid: A double-blind randomized controlled trial. J Obstet Gynaecol India 2019;69:173-9.
13.	Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth 2004;93:842-58.
14.	Gupta K, Rastogi B, Krishan A, Gupta A, Singh VP, Agarwal S. The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study. Anesth Essays Res 2012;6:70-3. [Full text]
15.	Kakar PN, Gupta N, Govil P, Shah V. Efficacy and safety of tranexamic acid in control of bleeding following TKR: A randomized clinical trial. Indian J Anaesth 2009;53:667-71. [PUBMED] [Full text]
16.	Celebi N, Celebioglu B, Selcuk M, Canbay O, Karagoz AH, Aypar U. The role of antifibrinolytic agents in gynecologic cancer surgery. Saudi Med J 2006;27:637-41.
17.	Lemay E, Guay J, Côté C, Roy A. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anaesth 2004;51:31-7.
18.	Wu CC, Ho WM, Cheng SB, Yeh DC, Wen MC, Liu TJ, et al. Perioperative parenteral tranexamic acid in liver tumor resection: A prospective randomized trial toward a “blood transfusion”-free hepatectomy. Ann Surg 2006;243:173-80.
19.	Shakur H, Roberts I, Fawole B, Chaudhri R, El-Sheikh M, Akintan A, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): An international, randomised, double-blind, placebo-controlled trial. Lancet 2017;389:2105-16.
20.	Sukriti Bhutani, Roopa Malik, Nirmala Duhan. Role of Intravenous Tranexamic acid (TXA) in reducing perioperative blood loss in hysterectomy for benign gynecological conditions. Authorea. 2020: 1-8.

Advanced Biomedical Research