Effectiveness of the use of intravenous tranexamic acid and pericervical tourniquet in decreasing peri-operative blood loss following open abdominal myomectomy:A randomized controlled trial.

Abstract

Background: Uterine fibroid is the most common gynaecological tumour, with a prevalence of 20% to 50% of women over 30years.Abnormal uterine bleeding is one of the most common modes of presentation with menorrhagia. Open abdominal myomectomy is the most common treatment option in our environment. It is associated with a significant degree of blood loss, with consequent blood transfusion. Thus, the need for interventions to reduce blood loss during the procedure. This study assessed the effectiveness of intravenous tranexamic acid in reducing blood loss when used as an adjunct to peri-cervical tourniquet during open abdominal myomectomy.

Methodology: This study was conducted at Barau Dikko Teaching Hospital, Kaduna. It comprised thirty-six consenting patients scheduled for elective open abdominal myomectomy, randomly assigned to receive either intravenous tranexamic acid or placebo immediately after securing intravenous access in the theatre. All the patients had a peri-cervical tourniquet applied intraoperatively. The volume of intraoperative blood loss, blood transfusion rate and the total number of units transfused, haemodynamic changes associated with blood loss, and the complications associated with the use of tranexamic acid were evaluated during the first 72hours following the surgery.

Results: A total of thirty-six women who met the eligibility criteria were studied between June 2023 and December 2023. The mean age of the participants in the tranexamic acid group was 37.82 ± 5.89 years and 39.74 ± 5.17 years in the placebo group (p = 0.307). Most of the women 35 (97.2%) presented with symptoms of menorrhagia. Major blood loss > 1000 ml was recorded more among women in the placebo group than those who received tranexamic acid. There was a statistically significant reduction in the mean blood loss in the tranexamic acid group 947.65 ± 451.88 compared to 1320.53 ± 563.28. (p 0.037).There was an increase in the number of women who received a blood transfusion in the placebo group 7 (36.8%) compared to the tranexamic acid group 4 (23.5%) (p=0.387). Tranexamic acid resulted in a decrease in the risk of perioperative blood loss by 30%, RR 0.7 95% CI (2.19-2.59) and packed cell volume was significantly lower in the control group postoperatively (P value = .001). There was no significant side effect noticed in both groups.

Conclusion: Tranexamic acid reduces blood loss during and after myomectomy for patients with uterine fibroids and the need for blood transfusion is reduced in patients who had intravenous tranexamic acid as an adjunct to the application of a tourniquet.