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

作者：Topsoee Marta F^*; Settnes Annette; Ottesen Bent; Bergholt Thomas

来源：International Journal of Gynecology & Obstetrics, 2017, 136(2): 120-127.

DOI：10.1002/ijgo.12047

• Antifibrinolytic agent
• Antifibrinolytic therapy
• Bleeding prophylaxis
• Obstetric and gynecologic surgery
• Surgical bleeding
• Tranexamic acid

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.

• 出版日期2017-2