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

Abstract

Background. Myomectomy can be associated with life-threatening conditions such as bleeding. Excessive bleeding usually necessitates blood transfusion. Interventions to reduce bleeding during myomectomy will help reduce the need for blood transfusion with its associated complications. Tranexamic acid has been used to reduce bleeding in other surgical procedures, and its usage during myomectomy merits evaluation. Objective. To assess the efficacy of tranexamic acid in reducing myomectomy-associated blood loss. Materials and Methods. This is a prospective double-blinded randomized trial conducted on women who had abdominal myomectomy. Patients were randomized into two groups. The study group received perioperative intravenous tranexamic acid (TXA) while the control group received a placebo. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs. In addition, blood collected postoperatively from the wound drains and drapes were measured. Haemoglobin concentrations were determined preoperatively and on second postoperative day for all cases. Any adverse effect was noted in both groups. The data was processed using Epi Info software (7.2.1, CDC, Atlanta, Georgia). The relationships between categorical data were analyzed using $X^2$ and Student’s $t$-test to determine relationships between continuous variables, with a $P$ value of 0.05 considered statistically significant, and correlation coefficients were calculated using Pearson’s formula, and probability of 0.05 was set for statistical significance. Results. Symptomatic uterine myomas constituted 17.3% of all gynaecological admissions and 21.3% of gynaecological operations at Federal Teaching Hospital Abakaliki. The mean intraoperative blood loss among patients that had perioperative tranexamic acid infusion was $413.6\pm 165.6$ ml, while that of patients with placebo infusion was $713.6\pm 236.3$ ml. Perioperative tranexamic acid infusion therefore reduced mean intraoperative blood loss by 300 ml, and this was statistically significant ($\text{SMD}=-0.212$, 95% CI: −403.932 to −196.067, $P<0.0001$). Perioperative tranexamic acid reduced mean total blood loss by a value of 532.3 ml, and this is statistically significant ($\text{SMD}=30.622$, 95% CI: 393.308 to 670.624, $P<0.0001$). Tranexamic acid also improved postoperative haemoglobin concentration by 1.8 g/dl compared with placebo, and this is statistically significant ($\text{SMD}=-0.122$, 95% CI: 1.182 to 2.473, $P<0.0001$). Tranexamic acid infusion decreased hospital stay by about 2 days, and this difference was statistically significant ($\text{SMD}=-3.929$, 95% CI: -3.018 to –0.983, $P=0.0003$). There was no adverse drug reaction in the course of the study. Conclusion. The use of tranexamic acid during myomectomy reduced intraoperative and postoperative blood loss. It is also associated with decreased hospital stay. This trial is registered with NCT04560465.