Lottermann Nicole Cristina, Andreazza Nathalia Luiza, de Araújo Moura Cavalcante Matheus, Fernandez Laura Andrade, Vitola Gonçalvez Carla, Zhang Linjie
Universidade Federal do Rio Grande Rio GrandeRS Brazil Universidade Federal do Rio Grande, Rio Grande, RS, Brazil.
Rev Bras Ginecol Obstet. 2025 Apr 30;47. doi: 10.61622/rbgo/2025rbgo18. eCollection 2025.
This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures.
We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term "tranexamic acid". Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively.
Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate.
This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.
本伞状综述旨在综合来自关于氨甲环酸在妇产科手术中疗效的临床试验系统评价的证据。
我们于2024年3月11日在Medline、Embase、SciELO和Cochrane系统评价数据库中检索，使用了“氨甲环酸”一词。四名评审员独立选择研究并提取数据。我们分别使用AMSTAR 2和GRADE工具评估系统评价的质量和证据的质量。
在识别出的651篇系统评价中，纳入了16篇涉及96663名患者的评价。手术操作包括剖宫产、子宫肌瘤切除术、子宫切除术和宫颈上皮内瘤变手术。所有评价均显示，静脉内或局部使用氨甲环酸与术中及术后失血量在统计学上有显著且临床相关的减少有关。在剖宫产中，氨甲环酸显著减少了输血需求，术后血细胞比容和血红蛋白水平下降幅度较小。几篇评价探讨了相同的问题，但纳入试验的数量差异很大，这可能表明这些评价在研究检索和选择方面存在缺陷。系统评价的质量较低或极低，证据质量为中等。
本伞状综述表明，氨甲环酸可减少妇产科手术中的失血和出血。仍需要高质量的系统评价。
