Among women with large uterine fibroids, the use of tranexamic acid (TXA) reduced blood loss during myomectomies, according to a retrospective cohort study.

Patients who underwent a myomectomy to remove uterine fibroids with a total weight greater than 173 g had lower estimated blood loss after receiving TXA compared with those who did not (205.6 mL vs 405.4 mL, P=0.006), reported Rachel Cullifer, MD, of the ChristianaCare Health System in Newark, Delaware.

Additionally, patients whose largest fibroid was greater than 73 mm had lower levels of blood loss with TXA (229.2 mL vs 408.3 mL, P=0.01), she noted during her virtual presentation at the American Association of Gynecologic Laparoscopists (AAGL) annual meeting.

“TXA is a highly safe hemostatic agent that gynecologic surgeons can utilize during myomectomies,” Cullifer said. “There is a role for TXA in myomectomies performed with a minimally invasive approach,” she added, noting that the treatment should be strongly considered for patients who are suspected of having a large fibroid burden.

When looking at all myomectomies not stratified by fibroid characteristics, estimated blood loss was not significantly different between patients who received TXA and those who did not (184 mL vs 266 mL, P=0.42).

None of the patients in the study required a blood transfusion. The average operating time was nearly 4 hours, and was not significantly different between the two groups.

The cumulative incidence of fibroids is estimated to be greater than 80% in Black women, and 70% in white women, Cullifer said. Fibroids are the primary indication for hysterectomy in the U.S., but myomectomy provides a safe alternative for those who want to preserve their fertility.

“Despite advances in laparoscopic techniques, blood loss and blood transfusions still remain higher in myomectomies when compared with hysterectomy,” Cullifer pointed out, adding that elevated plasmin levels during surgery can lead to prolonged bleeding. TXA works to decrease the productivity and function of plasmin and reduce blood loss, she stated.

Cullifer and colleagues looked specifically at fibroid characteristics to determine which patients might benefit most from TXA.

They analyzed 71 patients who underwent a myomectomy from 2015 to 2020. All patients were treated at an academic-affiliated community hospital system. Cullifer’s group compared myomectomy cases treated with TXA versus those that were not, and measured estimated blood loss, blood transfusion administration, and operative time.

Of all patients who had a myomectomy, 26 received TXA and 45 did not. The average estimated blood loss was 236 mL. Nearly all patients underwent minimally invasive procedures, with 53% undergoing laparoscopic surgery and 40% undergoing robot-assisted procedures.

The mean age of all study participants was nearly 34, and about 60% of patients were Black. All demographic characteristics were similar between the two groups, with the exception of age. Patients who received TXA were an average of two and a half years younger than those who did not. Additionally, fibroid characteristics were similar between the two groups.

Cullifer noted that adverse events were also similar between the two groups. None of the patients experienced anaphylaxis; there was one case of thromboembolism in the cohort who did not receive TXA. Rates of nausea, vomiting, and headaches also did not differ between the groups.