Vasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes

Vasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Vasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes Atul Kumar Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9302415/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION: Hemorrhage represents a significant complication during laparoscopic myomectomy, with transfusion requirements occurring in 5–40% of procedures. Vasopressin, a potent vasoconstrictor, has been employed for hemostasis in gynecologic surgery but evidence regarding its efficacy and safety for laparoscopic myomectomy has not been systematically synthesized. This systematic review and meta-analysis comprehensively evaluates vasopressin efficacy and safety for hemostasis during laparoscopic fibroid removal EVIDENCE ACQUISITION: Systematic search of PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus databases conducted until November 28, 2025, identified studies comparing vasopressin to control interventions during laparoscopic myomectomy. Randomized controlled trials and observational comparative studies reporting blood transfusion requirement, blood loss, or adverse events were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2 and ROBINS-I tools. Random-effects meta-analysis calculated pooled odds ratios (OR) for transfusion and mean differences (MD) for blood loss. GRADE methodology assessed evidence certainty. Subgroup analyses evaluated effect modification by fibroid characteristics, study quality, and surgical approach EVIDENCE SYNTHESIS: Twelve studies (1,348 participants) met inclusion criteria. Pooled analysis of seven studies demonstrated vasopressin reduced blood transfusion requirement by 72% compared to control (OR 0.28, 95% CI: 0.13–0.61, P = 0.002; number needed to treat = 8, 95% CI: 5–20). Eight studies showed vasopressin reduced intraoperative blood loss by approximately 122 mL (MD -122.45 mL, 95% CI: -204.31 to -40.58, P = 0.004; I²=78%). Six studies demonstrated hemoglobin preservation with vasopressin (1.23 g/dL greater than control, P < 0.0001). Safety analysis of 10 studies identified hypertension as the most common adverse event (3.9% vasopressin vs. 0.5% control), predominantly mild, self-resolving within 15–25 minutes. No deaths or permanent complications attributable to vasopressin were documented. Subgroup analyses revealed greatest benefit in large fibroids (> 8 cm; number needed to treat = 3) and multiple fibroids (number needed to treat = 3). Effect remained robust when high-risk studies were excluded (OR 0.22), suggesting findings not driven by bias. Trim-and-fill adjustment for publication bias yielded adjusted OR 0.54 (95% CI: 0.31–0.95), maintaining statistical significance. Evidence quality: GRADE moderate certainty for transfusion outcome, moderate for hemoglobin, low for blood loss due to high heterogeneity reflecting measurement methodology variation CONCLUSIONS: This meta-analysis demonstrates substantial hemostatic efficacy of vasopressin for laparoscopic myomectomy, reducing transfusion requirement by 72% and blood loss by approximately 120 mL, with a favorable safety profile when dilute formulations are employed. Vasopressin use should be considered a standard hemostatic adjunct during laparoscopic myomectomy, particularly in women with large or multiple fibroids at heightened hemorrhage risk. Future research should establish optimal vasopressin dosing protocols, investigate long-term pregnancy outcomes, and compare vasopressin efficacy across different surgical populations. Clinical Pharmacology Laparoscopic myomectomy Vasopressin Transfusion Full Text Additional Declarations The authors declare no competing interests. Supplementary Files ABSTRACTSRMA.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9302415","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":616554214,"identity":"52fd5fa3-175c-436f-ab36-8b8806d3c072","order_by":0,"name":"Atul Kumar Singh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYHACxgMMDBJAxHyMGSrQgF8DGwMDVAtbGklagECCx4yZKFfxz+8xOMDwxyJPPrrn2+PCNgZ5/gbmtgf4tEgc4zE4wNgmUWx45+x245ltDIYzDjC2G+C1BqylQSJx44zcbdK8bQyMGxiAJuDTIQ/SwvAHpCXnGUiLPUEtBmAtbBKJ8yVy2EBaEglqMTyWVnAgsU0icYNEmrkxzzmJ5BmHCWiRO3x444MPf+oS589IfvaYp8zGtr+9/RleLWCQAHLhATATqJi42AEC+QZiVY6CUTAKRsGIAwBAdkUzlQrfPAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-7034-8577","institution":"Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Atul","middleName":"Kumar","lastName":"Singh","suffix":""}],"badges":[],"createdAt":"2026-04-02 11:15:16","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9302415/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9302415/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106094480,"identity":"b6ce419e-c46a-470e-8350-f3cb05855ae5","added_by":"auto","created_at":"2026-04-03 11:42:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1015588,"visible":true,"origin":"","legend":"","description":"","filename":"VASOPRESSINsrmacitedupdated1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9302415/v1_covered_44ac9767-6a91-4f8a-9723-c8c32c207b26.pdf"},{"id":106074311,"identity":"77af99b6-3ce3-4c67-99a2-dcae4207ef92","added_by":"auto","created_at":"2026-04-03 07:13:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15271,"visible":true,"origin":"","legend":"","description":"","filename":"ABSTRACTSRMA.docx","url":"https://assets-eu.researchsquare.com/files/rs-9302415/v1/46a3d10a1c5e63a5c1132a00.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eVasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Laparoscopic myomectomy, Vasopressin, Transfusion","lastPublishedDoi":"10.21203/rs.3.rs-9302415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9302415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eINTRODUCTION: Hemorrhage represents a significant complication during laparoscopic myomectomy, with transfusion requirements occurring in 5\u0026ndash;40% of procedures. Vasopressin, a potent vasoconstrictor, has been employed for hemostasis in gynecologic surgery but evidence regarding its efficacy and safety for laparoscopic myomectomy has not been systematically synthesized. This systematic review and meta-analysis comprehensively evaluates vasopressin efficacy and safety for hemostasis during laparoscopic fibroid removal\u003c/p\u003e \u003cp\u003eEVIDENCE ACQUISITION: Systematic search of PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus databases conducted until November 28, 2025, identified studies comparing vasopressin to control interventions during laparoscopic myomectomy. Randomized controlled trials and observational comparative studies reporting blood transfusion requirement, blood loss, or adverse events were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2 and ROBINS-I tools. Random-effects meta-analysis calculated pooled odds ratios (OR) for transfusion and mean differences (MD) for blood loss. GRADE methodology assessed evidence certainty. Subgroup analyses evaluated effect modification by fibroid characteristics, study quality, and surgical approach\u003c/p\u003e \u003cp\u003eEVIDENCE SYNTHESIS: Twelve studies (1,348 participants) met inclusion criteria. Pooled analysis of seven studies demonstrated vasopressin reduced blood transfusion requirement by 72% compared to control (OR 0.28, 95% CI: 0.13\u0026ndash;0.61, P\u0026thinsp;=\u0026thinsp;0.002; number needed to treat\u0026thinsp;=\u0026thinsp;8, 95% CI: 5\u0026ndash;20). Eight studies showed vasopressin reduced intraoperative blood loss by approximately 122 mL (MD -122.45 mL, 95% CI: -204.31 to -40.58, P\u0026thinsp;=\u0026thinsp;0.004; I\u0026sup2;=78%). Six studies demonstrated hemoglobin preservation with vasopressin (1.23 g/dL greater than control, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Safety analysis of 10 studies identified hypertension as the most common adverse event (3.9% vasopressin vs. 0.5% control), predominantly mild, self-resolving within 15\u0026ndash;25 minutes. No deaths or permanent complications attributable to vasopressin were documented. Subgroup analyses revealed greatest benefit in large fibroids (\u0026gt;\u0026thinsp;8 cm; number needed to treat\u0026thinsp;=\u0026thinsp;3) and multiple fibroids (number needed to treat\u0026thinsp;=\u0026thinsp;3). Effect remained robust when high-risk studies were excluded (OR 0.22), suggesting findings not driven by bias. Trim-and-fill adjustment for publication bias yielded adjusted OR 0.54 (95% CI: 0.31\u0026ndash;0.95), maintaining statistical significance. Evidence quality: GRADE moderate certainty for transfusion outcome, moderate for hemoglobin, low for blood loss due to high heterogeneity reflecting measurement methodology variation\u003c/p\u003e \u003cp\u003eCONCLUSIONS: This meta-analysis demonstrates substantial hemostatic efficacy of vasopressin for laparoscopic myomectomy, reducing transfusion requirement by 72% and blood loss by approximately 120 mL, with a favorable safety profile when dilute formulations are employed. Vasopressin use should be considered a standard hemostatic adjunct during laparoscopic myomectomy, particularly in women with large or multiple fibroids at heightened hemorrhage risk. Future research should establish optimal vasopressin dosing protocols, investigate long-term pregnancy outcomes, and compare vasopressin efficacy across different surgical populations.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e","manuscriptTitle":"Vasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-03 07:13:01","doi":"10.21203/rs.3.rs-9302415/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10d668ae-8921-4652-9c15-a481ba457d3c","owner":[],"postedDate":"April 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65610658,"name":"Clinical Pharmacology"}],"tags":[],"updatedAt":"2026-04-03T07:13:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-03 07:13:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9302415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9302415","identity":"rs-9302415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}