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Effectiveness of prophylactic pharmacological hemostatic agents for reduction of blood loss at vaginal surgery: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

The objective was to evaluate the effectiveness of pharmacological hemostatic agents in the reduction of blood loss at vaginal surgery.

Methods

A systematic review of randomized control trials (RCTs) was completed. We searched PubMed (1946–2022), Embase, and CINAHL, using search terms related to vaginal hysterectomies and reconstructive surgeries combined with peri-operative use of hemostatic agents. RCTs comparing hemostatic interventions with placebo or with standard care were analyzed with the primary outcome of estimated blood loss. Secondary outcomes included peri-operative complications, length of stay, blood transfusion, and readmission. Risk of bias was assessed using the Risk of Bias 2 tool.

Results

Nine RCTs were included with a total of 903 participants. All trials were considered to have an overall low risk of bias. Meta-analysis of six RCTs (491 participants) favored the use of vasoconstrictive agent (vasopressin/ornipressin) at the surgical site for an overall effect estimate of decreased blood loss by 70 ml (95% CI −125, −14 ml). There was significant heterogeneity of studies with both dose and technique of vasoconstrictive agents used. Only one RCT evaluated tranexamic acid and found a benefit in the prophylactic use of intravenous tranexamic acid.

Conclusions

Peri-operative use of vasoconstrictive agents slightly reduces bleeding in women undergoing elective vaginal surgery. Additional studies evaluating alternative pharmacological agents such as tranexamic acid may be of benefit.

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Acknowledgements

We are grateful to Karine Fournier (Research librarian, Health Sciences Library, University of Ottawa) for her assistance with development of the search strategy.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON, Canada

    Yiming Cui & Innie Chen

  2. University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada

    Yiming Cui, Innie Chen, Andie Chernoff & Aisling Clancy

  3. The Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Innie Chen & Aisling Clancy

  4. Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Aisling Clancy

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  1. Yiming Cui
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  2. Innie Chen
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  4. Aisling Clancy
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Contributions

Y.C. contributed to the conception and design of study, data acquisition and analysis, and the writing of the manuscript. I.C. contributed to writing of the manuscript. A.C. contributed to data acquisition and writing of the manuscript. A.A.C. contributed to the conception, design of study, revision, and statistical analysis. All authors approved the final version of the manuscript.

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Correspondence to Aisling Clancy.

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The authors have no conflicts of interest. No financial support was obtained.

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Cui, Y., Chen, I., Chernoff, A. et al. Effectiveness of prophylactic pharmacological hemostatic agents for reduction of blood loss at vaginal surgery: a systematic review and meta-analysis. Int Urogynecol J 34, 2945–2957 (2023). https://doi.org/10.1007/s00192-023-05614-1

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  • DOI: https://doi.org/10.1007/s00192-023-05614-1

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