Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Eur J Obstet Gynecol Reprod Biol. 2022 Sep;276:82-91. doi: 10.1016/j.ejogrb.2022.07.004. Epub 2022 Jul 9.
To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy.
Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model.
Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03).
Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities.
系统评价和荟萃分析预防性氨甲环酸（TXA）与对照（生理盐水/无治疗）在子宫肌瘤剔除术中的临床疗效和安全性的随机对照试验。
从创建到 2022 年 2 月 21 日，筛选了 6 个数据库。对合格的研究进行了偏倚风险评估。使用随机效应模型，将结局汇总为均数差值（MD）和风险比（RR）及 95%置信区间（CI）。
纳入了 7 项研究，共 8 个组 571 例患者（TXA=304 例，对照组=267 例）。纳入的研究整体偏倚风险较低。预防性 TXA 组术中失血量（MD=-224.34ml，95%CI[-303.06，-145.61]，p<0.001）、术后失血量和总失血量均显著减少。此外，预防性 TXA 组术后平均血红蛋白（MD=0.4mg/dl，95%CI[0.11，0.68]，p=0.006）和平均血细胞比容水平也显著升高。虽然预防性 TXA 组的平均住院时间显著缩短（MD=-0.39d，95%[-0.74，-0.04]，p=0.03），但两组之间的手术时间和输血率没有显著差异。两组均无血栓栓塞事件发生。预防性 TXA 组恶心发生率明显升高（RR=2.68，95%CI[1.11，6.43]，p=0.03）。
在接受子宫肌瘤剔除术的患者中，预防性 TXA 基本安全，并可显著减少围手术期失血及相关并发症。
