Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study.

Background: The most common nutritional deficiency condition in the world is anaemia. Hysterectomy is the second-most frequently performed major surgery on women in the world. Amongst the list of per-operative and post-operative complications associated with hysterectomy of all routes, blood loss is one of the most common complications, leading to mortality and morbidity of the patient. Tranexamic acid has been proven to lower blood loss in various other surgical and non-surgical fields. Hence, the purpose of this study is to investigate the anti-haemorrhagic effect of prophylactic tranexamic acid in blood loss in hysterectomy for benign conditions.

Methods: A randomized prospective study was conducted at JSS Medical Hospital, Mysuru. A total of 272 women between the age of 35-60 years undergoing abdominal, vaginal or laparoscopic hysterectomy for benign conditions were taken for the study, grouped randomly to either case group or control group. Case group received 1 g tranexamic acid diluted in 10ML normal saline via intravenous route at the beginning of surgery. Control group were not given anything. Intraoperative blood loss was calculated by addition of weight difference of wet and dry mops, wet and dry perineal sheet, amount of blood collected in suction drain. Gravimetric method was for calculation. Postoperatively need of parenteral iron injection or blood transfusion was seen. Data were tabulated using Microsoft Excel data sheet. SPSS 22 version software was used to analyse the data.

Results: In the study, mean blood loss among cases was 238.16 ± 92.16 mL, among controls was 375.96 ± 137.77 mL with  = 0.001. The mean blood loss of subjects with TAH, VH and TLH was more with controls than with cases. Blood loss associated with TAH was more as compared to VH and least being with TLH. The mean fall in Hb among cases was 0.71 ± 0.53 g/dL, among controls was 1.18 ± 0.74 g/dL. Usage of post-operative parenteral iron and blood transfusion was higher in controls as compared to cases.

Conclusion: Prophylactic usage of tranexamic acid in hysterectomy for benign conditions lowers the blood loss and the need for post-operative interventions, morbidity, mortality.