Local Tranexamic Acid Infiltration for Prophylactic Hemorrhage Control in Vaginal Hysterectomy: Double-Blinded...

Area of Science:

• Gynecology
• Surgical Hemostasis
• Pharmacology

Background:

• Tranexamic acid (TXA) is an established antifibrinolytic agent promoting hemostasis.
• Intravenous TXA is widely used prophylactically in surgery.
• Limited data exist on local TXA administration for reducing surgical blood loss.

Purpose of the Study:

• To evaluate the efficacy of local tranexamic acid infiltration in reducing intraoperative blood loss.
• To assess the impact of local TXA on hemoglobin change and transfusion rates.
• To determine if local TXA improves surgical conditions during vaginal hysterectomy.

Main Methods:

• Double-blind, randomized, placebo-controlled trial.
• Sixty women undergoing benign vaginal hysterectomy.
• Local cervical/vaginal infiltration of 1g TXA or placebo pre-incision.

Main Results:

• No significant difference in mean hemoglobin reduction between TXA and placebo groups (1.48 vs 1.27 g/dl, p=0.36).
• Estimated blood loss, transfusion rates, and operative parameters were comparable.
• Significantly easier mucosal dissection observed in the TXA group (86.7% vs 40.0%, p<0.01).
• No thromboembolic events were reported.

Conclusions:

• Prophylactic local tranexamic acid did not reduce total blood loss in vaginal hysterectomy.
• Local TXA may improve surgical ease, specifically mucosal dissection.
• Vaginal hysterectomy is a safe procedure with generally minimal bleeding.