Efficacy of Preoperative Intravenous Tranexamic Acid to Reduce Blood Loss in Difficult Abdominal Hysterectomy for Benign Gynecological Disease: A randomized double-blind placebo-controlled trial
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Abstract
Objective: To determine the efficacy of tranexamic acid (TXA) in reducing intraoperative blood loss in difficult abdominal hysterectomy for benign gynecological disease.
Materials and Methods: A double-blinded randomized controlled trial was conducted. Women who were at risk of a difficult abdominal hysterectomy for benign gynecological disease, with or without adnexal surgery, were included. The participants were randomly assigned into two groups, comprising an intervention group who received intravenous TXA 10mg/kg (diluted with normal saline up to 100 ml), and a control group who received 100 ml of normal saline 15 minutes before skin incision.
Results: Ninety-two eligible participants were randomly allocated into the intervention group (n = 46) and control groups (n = 46) between September 2024 and July 2025. Intraoperative measurement of blood loss was comparable between the TXA group and control group (median [IQR]: 239 [104–384] vs. 280 [187–400] mL, p = 0.24), and the incidence of blood loss exceeding 500 mL did not differ significantly between the groups (11.1% vs. 22.2%, p = 0.26). There were no statistically significant differences, including in changes in hemoglobin levels and blood transfusion requirements. Additional perioperative TXA in the TXA group was significantly lower than in the control group (4.4% vs. 22.2%; p = 0.03). No serious adverse effects were observed.
Conclusion: Preoperative intravenous TXA did not reduce blood loss in cases of difficult abdominal hysterectomy for benign gynecological disease.
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