TRANEXAMIC ACID IN GYNAECOLOGIC SURGERY – A REVIEW OF THE LITERATURE

Abstract

Objectives The primary objective is to summarize current evidence for tranexamic acid (TXA) use in gynaecologic surgery. Secondary objectives include reviewing the mechanism of action, dosing, and adverse effects related to TXA use. Methods A literature search was performed using PubMed, Ovid (MEDLINE), Google Scholar, Elsevier, and of cited references pertaining to TXA use in gynaecologic surgery. Additionally, articles discussing TXA pharmacology and complications were included. Current literature was synthesized based on gynaecologic procedure. Results TXA prevents the degradation of fibrin clots by blocking the activation of plasminogen to plasmin, and is typically dosed at 1g intravenously immediately pre-operatively. Although a large body of evidence supports TXA use in other surgical specialties, data on TXA use in gynaecologic surgery is limited. At hysterectomy, TXA has been shown to reduce estimated intraoperative blood loss, incidence of major bleeding, risk of reoperation for hemorrhage and is associated with a lower rate of blood transfusion. At myomectomy, some evidence supports reductions in blood loss and change in hemoglobin following TXA use, while others show no effect. Importantly, no studies report an increased risk of adverse events related to TXA administration in the gynaecologic setting. Limited evidence also exists for TXA use in preventing blood loss in other gynaecologic surgeries including ovarian cancer cytoreduction, cervical conization, and hysteroscopy. Conclusions Although evidence exists to support TXA as a safe and valuable agent for reducing surgical blood loss, more studies are required to validate its benefit in gynaecologic surgery.