Intravenous Tranexamic Acid Combined With Intramyometrial Desmopressin During Laparoscopic Myomectomy: A Randomized Double-Blind Placebo-Controlled Trial

Abstract

Objective

To evaluate whether intravenous tranexamic acid combined with intramyometrial desmopressin reduces perioperative blood loss during laparoscopic myomectomy.

Design

A prospective, randomized, double-blind, placebo-controlled trial.

Setting

A tertiary university hospital.

Patients

One hundred women undergoing laparoscopic myomectomy for symptomatic uterine fibroids were included in the study. Patients with suspected malignancy, thromboembolic disease, significant systemic illness, abnormal coagulation, anticoagulant use, body mass index ≥30 kg/m², or concomitant surgical procedures were excluded.

Interventions

Participants were randomized to receive intravenous tranexamic acid 1 g (n = 50) or placebo (normal saline; n = 50). All patients received intramyometrial desmopressin (30 mcg diluted in 100 mL normal saline).

Measurements and Main Results

Median estimated blood loss did not differ significantly between the tranexamic acid and placebo groups (150 mL vs 100 mL; p = .269). Transfusion rates were similar (10% vs 6%; p = .715). Postoperative hemoglobin levels were comparable between groups (p = .505). Surgeon-rated operative difficulty scores were significantly higher in Group I than in Group II (median score: 6 vs 5, p = .016). Multivariable regression identified myoma number (B = 19.09 mL per myoma; 95% CI: 8.31–29.86; p = .001) and myoma diameter (B = 2.02 mL per cm; 95% CI: 0.18–3.85; p = .032) as independent predictors of blood loss. Increasing age was independently associated with blood transfusion risk (odds ratio 1.18; 95% CI: 1.00–1.38; p = .044).

Conclusion

Tranexamic acid was safe but did not significantly reduce estimated blood loss or the need for transfusion compared with the placebo. Routine combined use is not supported; however, further evaluation in patients with a higher myoma burden may be warranted.