A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery

Int J Gynaecol Obstet. 2017 Feb;136(2):120-127. doi: 10.1002/ijgo.12047. Epub 2016 Dec 9.


Background: The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.

Objectives: To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.

Search strategy: PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.

Selection criteria: Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.

Data collection and analysis: Basic information and outcomes were collected and meta-analyses performed.

Main results: Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).

Conclusions: Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.

Keywords: Antifibrinolytic agent; Antifibrinolytic therapy; Bleeding prophylaxis; Obstetric and gynecologic surgery; Surgical bleeding; Tranexamic acid.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antifibrinolytic Agents / therapeutic use*
  • Blood Loss, Surgical / prevention & control*
  • Blood Transfusion / statistics & numerical data
  • Cesarean Section*
  • Female
  • Gynecologic Surgical Procedures*
  • Humans
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Tranexamic Acid / therapeutic use*


  • Antifibrinolytic Agents
  • Tranexamic Acid