Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials
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To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacyand safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy forbenign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed forrisk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervalsin a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two andthree studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirementfor postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantlyreduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobinlevel was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequencyof self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhearate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolicevents, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivityanalyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions,prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative bloodloss and related morbidities.
Abstract
To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacyand safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy forbenign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed forrisk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervalsin a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two andthree studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirementfor postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantlyreduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobinlevel was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequencyof self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhearate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolicevents, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivityanalyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions,prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative bloodloss and related morbidities.
참고문헌 (50)
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