Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study

Arvind R; Rachana Arvind; M Poornima; Poornima M; S Mamatha; Mamatha S; K Sowmya; Sowmya K; Chaitanya KT

doi:10.1007/s13224-024-01983-9

Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study

Arvind R, Rachana Arvind, M Poornima, Poornima M, S Mamatha, Mamatha S, K Sowmya, Sowmya K, Chaitanya KT

Journal of obstetrics and gynaecology of India · 2025 · vol. 75(Suppl 1) , pp. 43–51 · doi:10.1007/s13224-024-01983-9 · PMID:40390872 · PMC12085737

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This randomized controlled study of 272 women found that prophylactic intravenous tranexamic acid significantly reduced intraoperative blood loss and postoperative interventions in hysterectomies for benign conditions such as endometriosis or adenomyosis.

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This randomized controlled study evaluated the impact of prophylactic intravenous tranexamic acid on blood loss during hysterectomies for benign conditions in 272 women aged 35 to 60. Participants receiving a 1 g dose at the start of surgery experienced significantly lower mean intraoperative blood loss and hemoglobin decline compared to the control group. Consequently, the treatment group required fewer post-operative parenteral iron injections and blood transfusions, indicating reduced morbidity associated with hemorrhage. Relevance to endometriosis: listed as one indication for hysterectomy when conservative management fails, though the paper's main focus is general benign uterine pathology rather than specific endometriosis or adenomyosis pathology.

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Abstract

BACKGROUND: The most common nutritional deficiency condition in the world is anaemia. Hysterectomy is the second-most frequently performed major surgery on women in the world. Amongst the list of per-operative and post-operative complications associated with hysterectomy of all routes, blood loss is one of the most common complications, leading to mortality and morbidity of the patient. Tranexamic acid has been proven to lower blood loss in various other surgical and non-surgical fields. Hence, the purpose of this study is to investigate the anti-haemorrhagic effect of prophylactic tranexamic acid in blood loss in hysterectomy for benign conditions. METHODS: A randomized prospective study was conducted at JSS Medical Hospital, Mysuru. A total of 272 women between the age of 35-60 years undergoing abdominal, vaginal or laparoscopic hysterectomy for benign conditions were taken for the study, grouped randomly to either case group or control group. Case group received 1 g tranexamic acid diluted in 10ML normal saline via intravenous route at the beginning of surgery. Control group were not given anything. Intraoperative blood loss was calculated by addition of weight difference of wet and dry mops, wet and dry perineal sheet, amount of blood collected in suction drain. Gravimetric method was for calculation. Postoperatively need of parenteral iron injection or blood transfusion was seen. Data were tabulated using Microsoft Excel data sheet. SPSS 22 version software was used to analyse the data. RESULTS: In the study, mean blood loss among cases was 238.16 ± 92.16 mL, among controls was 375.96 ± 137.77 mL with p = 0.001. The mean blood loss of subjects with TAH, VH and TLH was more with controls than with cases. Blood loss associated with TAH was more as compared to VH and least being with TLH. The mean fall in Hb among cases was 0.71 ± 0.53 g/dL, among controls was 1.18 ± 0.74 g/dL. Usage of post-operative parenteral iron and blood transfusion was higher in controls as compared to cases. CONCLUSION: Prophylactic usage of tranexamic acid in hysterectomy for benign conditions lowers the blood loss and the need for post-operative interventions, morbidity, mortality.

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Abstract

Background: The most common nutritional deficiency condition in the world is anaemia. Hysterectomy is the second-most frequently performed major surgery on women in the world. Amongst the list of per-operative and post-operative complications associated with hysterectomy of all routes, blood loss is one of the most common complications, leading to mortality and morbidity of the patient. Tranexamic acid has been proven to lower blood loss in various other surgical and non-surgical fields. Hence, the purpose of this study is to investigate the anti-haemorrhagic effect of prophylactic tranexamic acid in blood loss in hysterectomy for benign conditions.

Methods

A randomized prospective study was conducted at JSS Medical Hospital, Mysuru. A total of 272 women between the age of 35-60 years undergoing abdominal, vaginal or laparoscopic hysterectomy for benign conditions were taken for the study, grouped randomly to either case group or control group. Case group received 1 g tranexamic acid diluted in 10ML normal saline via intravenous route at the beginning of surgery. Control group were not given anything. Intraoperative blood loss was calculated by addition of weight difference of wet and dry mops, wet and dry perineal sheet, amount of blood collected in suction drain. Gravimetric method was for calculation. Postoperatively need of parenteral iron injection or blood transfusion was seen. Data were tabulated using Microsoft Excel data sheet. SPSS 22 version software was used to analyse the data.

Results

In the study, mean blood loss among cases was 238.16 ± 92.16 mL, among controls was 375.96 ± 137.77 mL with p = 0.001. The mean blood loss of subjects with TAH, VH and TLH was more with controls than with cases. Blood loss associated with TAH was more as compared to VH and least being with TLH. The mean fall in Hb among cases was 0.71 ± 0.53 g/dL, among controls was 1.18 ± 0.74 g/dL. Usage of post-operative parenteral iron and blood transfusion was higher in controls as compared to cases.

Conclusion

Prophylactic usage of tranexamic acid in hysterectomy for benign conditions lowers the blood loss and the need for post-operative interventions, morbidity, mortality.

Keywords

Haemorrhage; Hysterectomy; Prophylactic; Tranexamic acid (TXA). © Federation of Obstetric & Gynecological Societies of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Conflict of interest statement Conflict of interestThe authors declare that they have no conflict of interest. Figures

References

- - International institute for population sciences (IIPS) and macro international. National family health survey (NFHS-3), 2005–06: India: Mumbai: IIPS. Volume I. 2007 LinkOut - more resources Full Text Sources

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