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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References
International institute for population sciences (IIPS) and macro international. National family health survey (NFHS-3), 2005–06: India: Mumbai: IIPS. Volume I. 2007
Desai S, Shukla A, Nambiar D, Ved R. Patterns of hysterectomy in India: a national and state-level analysis of the fourth national family health survey (2015–2016). BJOG. 2019;126:72–80.
Wiesenfeld HC. Complications of hysterectomy. Obstet Gynecol. 2013;122(1):156.
English EM, Bell S, Kamdar NS, Swenson CW, Wiese H, Morgan DM. Importance of estimated blood loss in resource utilization and complications of hysterectomy for benign indications. Obstet Gynecol. 2019;133(4):650–7.
Foley JH. Plasminogen at the nexus of fibrinolysis, inflammation, and complement. Semin Thromb Hemost. 2017;43:135–42.
Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I. What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 2019;30(1):1–10.
McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585–617.
Astedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol Suppl. 1987;137:22–5.
Topsoee MF, Bergholt T, Ravn P, Schouenborg L, Moeller C, Ottesen B, Settnes A. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy-a double-blinded randomized placebo-controlled trial. Am J Obstet Gynecol. 2016;215(1):72.e1-8.
Arthi NP, Jalakandan B, Gunaseelan S. Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy. Int J Reprod Contracept Obstet Gynecol. 2018;7:3538–45.
Singh D, Bindal J. The effect of prophylactic use of intravenous tranexamic acid in hysterectomy of benign diseases. Int J Clin Obstet Gynaecol. 2020;4(3):93–7.
Jain SB. Decline in blood loss with use of tranexamic acid in cases of hysterectomy: a retrospective observational study in a teaching hospital of central India. Indian J Obstet Gynecol Res. 2021;8(1):26–30.
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The present paper was written according to appropriate ethical standards approved by the Institutional Ethical Committee of JSS Medical College, JSS Academy of Higher Education and Research, vide letter no. JSS/MC/PG/5156/2020-21, dated 22/01/2021.
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Rachana Arvind is Junior resident; Poornima M is an Associate Professor; Mamatha S is a Professor and Head of Department;Sowmya K is an Associate Professor; Chaitanya K T is a Senior Resident
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Arvind, R., Poornima, M., Mamatha, S. et al. Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study. J Obstet Gynecol India (2024). https://doi.org/10.1007/s13224-024-01983-9
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DOI: https://doi.org/10.1007/s13224-024-01983-9