The Efficacy and Safety of Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During Abdominal Myomectomy. A Randomized Comparative Study

Aim: The aim of the study is to compare the efficacy and safety of rectal Misoprostol versus IV Tranexamic acid (TXA) in reducing intraoperative blood loss during open myomectomy.
Design: A randomized comparative study.
Setting: KasrAlainy hospital Obstetrics and Gynecology department, Cairo University, Egypt, during the period from April 2021 and September 2021.
Methods: A total of 75 patients with uterine fibroid fulfilling the inclusion criteria were scheduled for abdominal myomectomy. Patients were randomized and allocated into one of three groups with a 1:1:1 allocation ratio. The groups were coded as A,B,C (group A for tranexamic acid ,group B for oxytocin and group C for control) (n=25 per group). In the three groups the following outcomes were reached : the estimated blood loss (EBL) during open myomectomy, need for intra and post operative blood transfusion, operative time, myomectomy time, postoperative hematocrit and hemoglobin, drop in postoperative hemoglobin , drop in hematocrit, side effects of TXA and oxytocin including and post operative stay in days.
Interventions: Group (A) (Tranexamic Acid group): Women received TXA as a single bolus intravenous injection of 15 mg/kg (maximum 1 g) slowly over 10 min 20 min before skin incision.
Group (B) (Misoprostol group): Women received two tablet of (200 microgram) misoprostol (Cytotec) rectally 1hr before starting of operation..
Group (C) (placebo group): Women received 500 ml saline infusion at a rate of 120 ml/h before and during the operation.
Results: Regarding need for intraoperative blood transfusion; statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups (no cases needed). On the other hand
there was highly significant difference with control group 33 (66.0%) (p= <0.001). Also, Regarding need for postoperative blood transfusion; tranexamic acid was significantly higher than misoprostol and control groups 6 (12.0%) vs. 0 (0.0%) vs. 3 (6.0%) respectively (p= 0.042). Regarding intraoperative blood loss (ml); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 229.35 ± 41.05 and 225.80 ± 44.82. On the other hand there was highly significant higher intraoperative blood loss in control group 680.35 ±189.39 (p= <0.001). Regarding post-operative stay (days); statistical analysis of current results showed that there was no significant difference between tranexamic acid and misoprostol groups 1.34 ± 0.48 vs. 1.32 ± 0.47. On the other hand there was highly significant longer stay in control group 1.56 ± 0.54 (p= 0.030).
Conclusion: In women undergoing abdominal myomectomies, preoperative intravenous tranexamic acid and rectal misoprostol were very effective in reducing intraoperative blood loss, need for intra and postoperative blood transfusion, post-operative stay and operation and myomectomy time compared with placebo.