Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy


  • Nivedhana Arthi P. Department of Obstetrics and Gynecology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Pondicherry, India
  • Jalakandan B. Department of Anaesthesiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Pondicherry, India
  • Gunaseelan S. Department of Anaesthesiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Pondicherry, India




Abdominal hysterectomy, Anemia, Antifibrinolytics, Fibrinolysis, Perioperative bleeding, Tranexamic acid


Background: The prevalence of anemia in India is so high that majority of women presenting for hysterectomy are already with borderline hemoglobin status and the perioperative blood loss puts them at risk of death and prolongs recovery. Antifibrinolytic agents, mainly Tranexamic acid (TXA) have been demonstrated to reduce blood loss and transfusion requirements in various surgeries. The present study was done to assess the efficacy of TXA in effectively reducing intraoperative blood loss and the need for transfusion in Indian population undergoing abdominal hysterectomy for benign indications.

Methods: This randomized, double-blind, placebo-controlled study was conducted on hundred patients undergoing abdominal hysterectomy. Group T (n = 50)- received TXA 15 mg/kg in 100 ml Normal saline and Group N (n = 50)-received the same volume of Normal saline infused over 15 minutes. Estimated blood loss need for blood transfusion, duration of surgery, postoperative hemoglobin and incidence of adverse events were noted.

Results: There was statistically significant reduction in mean blood loss in group T when compared to group N (360 ml versus 540 ml). Accordingly, there was significant difference in the number of patients requiring blood transfusion (12% versus 42%) and also the postoperative hemoglobin levels. The group T patients had a significantly shorter operating time (127.86 versus 148.64 minutes). None of the patients developed any major adverse events.

Conclusions: The prophylactic TXA safely and effectively reduces the blood loss and transfusion requirements in Indian patients undergoing abdominal hysterectomy for benign indications.


McLean E, Cogswell M, Egli I. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993-2005. Public Health Nutr. 2009;12:444-54.

Murphy WG, Davies MJ, Eduardo A. The haemostatic response to surgery and trauma. Br J Anaesth. 1993;70:205-13.

Chi BH. Translating clinical management into an effective public health response for postpartum haemorrhage. BJOG. 2015;122:211.

Levy JH, Dutton RP, Hemphill JC, Shander A, Cooper D, Paidas MJ. Hemostasis Summit Participants: Multidisciplinary approach to the challenge of hemostasis. Anesth Analg. 2010;110:354-64.

Wellington K, Wagstaff AJ. Tranexamic acid: Review of its use in management of menorrhagia. Drugs. 2003;63:1417.

Kongnyuy E, Wiysonge C. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD005355.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015 Jun 16;(6):CD007872.

Perel P, Ker K, Morales Uribe CH, Roberts I. Tranexamic acid for reducing mortality in emergency and urgent surgery. Cochrane Database Syst Rev. 2013 Jan 31;1(1):CD010245.

Topsoee MF, Bergholt T, Ravn P, Schouenborg L, Moeller C, Ottesen B et al. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy-a double-blinded randomized placebo-controlled trial. Am J Obstet Gynecol. 2016 Jul;215:72.e1-8.

Shaaban MM, Ahmed MR, Farhan RE. Efficacy of tranexamic acid on myomectomy- associated blood loss in patients with multiple myomas: a randomized controlled clinical trial. Reprod Sci. 2016;23:908-12.

Lethhaby A, Farquhar C, Cook I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(4):CD000249.

Chi C, Pollard D, Tuddenham EG. Menorrhagia in adolescents with inherited bleeding disorders. J Pediatr Adolesc Gynecol. 2010;23:215-22.

Mohri H. High dose of tranexamic acid for treatment of severe menorrhagia in patients with vonWillebrand disease. J Thromb Thrombolysis. 2002;14:255-7.

Mc Cormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72(5):585-617.

Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57:1005–32.

Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054.

Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23-32.

World Health Organization. Summary of the report of the 18th meeting of the WHO Expert Committee on the Selection and Use of Essential Medicines. Available at http://www.who.int/selection_medicines/committees/ TRS_web_summary.pdf. Published March 2011.

Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30:270-382

American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 2015;122:241-75.

National Family Health Survey (NFHS-III), 2005-2006. Available at http://www.nfhsindia.org/pdf/India.

Balarajan YS, Fawzi WW, Subramanian SV. Changing patterns of social inequalities in anaemia among women in India: cross-sectional study using nationally representative data. BMJ Open. 2013;3(3):e002233.

Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth. 2004;93:842-58.

Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs. 1985;29:236-61.

Al-Horani RA, Desai UR. Recent advances on plasmin inhibitors for the treatment of fibrinolysis-related disorders. Med Res Rev. 2014;34:1168-216.

Goobie SM. Tranexamic acid: still far to go. Br J Anaesth. 2017;118(3):293-5.

Ortmann E, Besser MW, Klein AA. Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth. 2013;111:549-63.

Goswami U, Sarangi S, Gupta S, Babbar S. Comparative evaluation of two doses of tranexamic acid used prophylactically in anaemic parturients for lower segment cesarean section: A double-blind randomized case control prospective trial. Saudi J Anaesth. 2013;7(4):427-31.

Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, et al. tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg. 1997;84:839-44.

Lundin ES, Johansson T, Zachrisson H, Leandersson U, Backman F, Falknas L, et al. Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study. Acta Obstet Gynecol Scand. 2014;93(4):335-44.

Bhavana G, Abhishek MV, Suneeta Mittal. Efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section. Int J Reprod Contracept Obstet Gynecol. 2016Jun;5(6):2011-6.

Gupta K, Rastogi B, Krishan A, Gupta A, Singh VP, Agarwal S. The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study. Anesth Essays Res. 2012;6:70-3.

Shady NW, Sallam HF, Fahmy H. Reducing blood loss during open myomectomy with intravenous versus topical tranexamic acid: A double-blinded randomized placebo-controlled trial. Middle East Fertil Soc J. 2018.

Ashraf Aly H, Ramadani HM. Assessment of blood loss during cesarean section under general anesthesia and epidural analgesia using different methods. AJAIC. 2006;9(1).

Celebi N, Celebioglu B, Selcuk M, Canbay O, Karagoz AH, Aypar U. The role of antifibrinolytic agents in gynecological cancer surgery. Saudi Med J. 2006;27:637-41.

Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic acid-associated seizures: causes and treatment. Ann Neurol. 2016;79:18-26.

Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest. 2012;122:4654-66.

Kratzer S, Irl H, Mattusch C, Bürge M, Kurz J, Kochs E et al. Tranexamic acid impairs gamma-amino butyric acid receptor type A-mediated synaptic transmission in the murine amygdala: a potential mechanism for drug-induced seizures? Anesthesiology. 2014;120:639-49.

Kalavrouziotis D, Voisine P, Mohammadi S, Dionne S, Dagenais F. High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass. Ann Thorac Surg. 2012;93:148-54

Goobie SM, Cladis FP, G CD, Huang H, Reddy SK, Fernandez A, et al. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Paediatr Anaesth. 2017;27(3):271-81.






Original Research Articles