Tourniquet with Intravenous Tranexamic Acid versus Tourniquet with Vaginal Misoprostol for Blood Loss Reduction during Open Myomectomy: A Double-Blind Randomised Trial.

BACKGROUND: Myomectomy has remained one of the main surgical techniques for managing uterine fibroids, especially in sub-Saharan Africa, where women desire to preserve their uterus for fertility and other cultural reasons. However, blood loss remains a major complication during myomectomy. The study's objective was to compare tourniquet with intravenous tranexamic acid and tourniquet with vaginal misoprostol in blood loss reduction during open myomectomy. METHODOLOGY: A double-blind randomised controlled trial with Pan-African Clinical Trials Registry approval number PACTR202406615201194 was conducted. A total of 78 eligible women for abdominal myomectomy were randomised into two groups. Participants in group I received 1g intravenous tranexamic acid intra-operatively after an incision was made on the uterus. They also had vaginal administration of folic acid into the posterior vaginal fornix one hour before the myomectomy for a placebo. Participants in group II received 400mcg vaginal misoprostol inserted into the posterior vaginal fornix one hour before the myomectomy. Both groups of women had tourniquets applied at the isthmic portion of the uterus to occlude the uterine arteries after delivery of the uterus before commencing the myomectomy procedure. RESULTS: Patients randomised into the tourniquet with tranexamic acid group had lesser intraoperative blood loss, lesser need for blood transfusion, and higher postoperative haemoglobin concentration compared to the tourniquet with vaginal misoprostol group, and these findings were statistically significant (p < 0.001, p = 0.0321, p < 0.001, respectively). There were no untoward side effects noted in either group. CONCLUSION: The results of this study suggest that the use of a tourniquet with intravenous tranexamic acid has a better effect in reducing blood loss than a tourniquet with vaginal misoprostol during open myomectomy.