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Int J Gynaecol Obstet. 2017 Feb;136(2):120-127. doi: 10.1002/ijgo.12047. Epub 2016 Dec 9.

A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery.

Author information

1
Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark.
2
Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
3
Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Abstract

BACKGROUND:

The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.

OBJECTIVES:

To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.

SEARCH STRATEGY:

PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.

SELECTION CRITERIA:

Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.

DATA COLLECTION AND ANALYSIS:

Basic information and outcomes were collected and meta-analyses performed.

MAIN RESULTS:

Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).

CONCLUSIONS:

Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.

KEYWORDS:

Antifibrinolytic agent; Antifibrinolytic therapy; Bleeding prophylaxis; Obstetric and gynecologic surgery; Surgical bleeding; Tranexamic acid

PMID:
28099726
DOI:
10.1002/ijgo.12047
[Indexed for MEDLINE]

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