Effects of Tranexamic Acid Administration at Time of Myomectomy with a Particular Focus on Fibroid Characteristics

Abstract

<h3>Study Objective</h3> To compare the effect of tranexamic acid (TXA) administration on estimated blood loss (EBL) in patients undergoing myomectomy. <h3>Design</h3> Retrospective cohort study of women undergoing myomectomy between January 2015 and January 2020. <h3>Setting</h3> Academic-affiliated community hospital system. <h3>Patients or Participants</h3> All women (n=71). who underwent myomectomy with a Minimally Invasive Gynecologic Surgeon (MIGS) at a single institution between January 2015 and January 2020. <h3>Interventions</h3> In 2017, the MIGS department underwent a practice change and began routine administration of TXA to all myomectomy cases without an absolute contraindication. <h3>Measurements and Main Results</h3> Overall mean EBL was 236mL. There was no statistically significant difference in EBL between the TXA (184mL) and no TXA groups (266mL) (p=0.42). However, when stratified by fibroid characteristics, patients with total pathology fibroid weight >173g or a largest fibroid >73mm had a statistically significant decrease in EBL when they received TXA compared to those who did not (No TXA vs TXA, 405.4mL vs 205.6mL, p=0.006 and 408.3mL vs 229.2mL, p=0.01, respectively). No patients required a blood transfusion. Average operating time was 238 minutes and was also not statistically different between the two groups (p=0.95). There were no cases of anaphylaxis in either group. There was one case of thromboembolism which occurred in the non-TXA group. Rates of nausea/vomiting and headaches did not differ between the two groups (p=1.0 and p=0.41, respectively). <h3>Conclusion</h3> There was a statistically significant reduction in blood loss at the time of myomectomy in patients with a large fibroid burden treated with TXA. Furthermore, TXA is demonstrated as a safe hemostatic agent associated with extremely low rates of adverse events. TXA is a safe and effective hemostatic agent that may reduce intraoperative blood loss during myomectomy.