Oxytocin, TA with ethamsylate show no significant value in lowering myomectomy blood loss

Key takeaways:

• Oxytocin or tranexamic acid (TA) with ethamsylate was not associated with significant blood loss for abdominal myomectomy vs. placebo.
• There were no significant differences in other secondary outcomes between the three groups.

Use of oxytocin or tranexamic acid with ethamsylate was not associated with significant reductions in intraoperative blood loss vs. placebo among women undergoing abdominal myomectomy, according to findings published in BMC Women’s Health.

Oxytocin’s intraoperative administration efficiently reduces blood loss during abdominal myomectomy surgery to manage uterine fibroids, according to study background. In addition, tranexamic acid (TA) inhibits plasminogen from being transformed into plasmin and ethamsylate prevents capillary bleeding, the researchers noted, and TA also increases capillary wall stability.

“Hence, based on their mechanism of action, the combination of TA and ethamsylate seems promising to reduce the bleeding tendency during abdominal myomectomy,” Ahmed Mahmoud Abdou, MD, from the department of obstetrics and gynecology at Zagazig University in Egypt, and colleagues wrote. “Thus, we conducted this randomized controlled trial to compare oxytocin efficacy and safety profile versus TA with ethamsylate for reducing blood loss during myomectomy.”

Abdou and colleagues conducted a randomized, double-blind multicenter study enrolling 180 premenopausal women from August to October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut and Al-Azhar University Hospitals of Damietta in Egypt. All women were randomly assigned to an injection of oxytocin 30 IU in 500 mL saline (n = 60; mean age, 31.08 years), injections of TA 1 g plus ethamsylate 250 mg and 110 mL saline (n = 60; mean age, 31.33 years) or an injection of 110 mL saline alone as placebo (n = 60; mean age, 29.52 years) prior to surgery.

Researchers observed no significant reduction in inoperative blood loss with oxytocin or with TA plus ethamsylate compared with the placebo for abdominal myomectomy (666.25 mL and 630.72 mL vs. 646.67 mL, respectively; P = .05).

Researchers also observed nonsignificant trends for reductions in operation time (P = .76), intraoperative and postoperative blood transfusion (P = .624), hospital stay (P = .986), postoperative fever (P = .659), postoperative parenteral iron transfusion (P = .901) and postoperative wound infection (P = 1). No women in this study required hysterectomy.

“Additional studies are still required to verify our findings and examine the influence of myomectomy type and fibroid features on the amount of blood lost during myomectomy,” the researchers wrote.