A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery.

BACKGROUND

The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.

OBJECTIVES

To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.

SEARCH STRATEGY

PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.

SELECTION CRITERIA

Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.

DATA COLLECTION AND ANALYSIS

Basic information and outcomes were collected and meta-analyses performed.

MAIN RESULTS

Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).

CONCLUSIONS

Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.