RESULTS
A total of 150 patients planned for hysterectomy for benign conditions were made a part of this prospective case-control study. Both the groups were matching with regard to demographic data (table 1) like blood pressure, pulse rate, and BMI. Heavy menstrual bleeding was seen as the most common complaint amongst the subjects undergoing hysterectomy, followed by the feeling of something coming out per vaginum while AUB-L was seen as the most common indication of hysterectomy followed by 3° cervical descent with rectocele and enterocele. Preoperative hemoglobin levels were shown to be higher in the control group, but an inverse correlation was found to be statistically significant (p<0.019). Similarly, postoperative hemoglobin values were found to be higher in the case group, which was statistically significant (p<0.031). There were a variety of routes followed for hysterectomy, out of which TAH with salpingectomy was the most common, followed by VH with anterior colporrhaphy and posterior colpoperineorrhaphy.As shown in table table 2, the mean intraoperative blood loss in the case group was seen to be 489 ml, while in the control group, it was 540ml, which was seen to be statistically significant. The intraoperative blood loss was overall decreased in the case group irrespective of the route of hysterectomy (table 3). This was found to be statistically significant only for vaginal hysterectomy with anterior colporrhaphy and posterior colpoperineorrhaphy. The difference in intraoperative blood loss between the case and the control groups was also found to be statistically significant (p<0.02). The weight of the hysterectomy sample obtained postoperatively was also found to be higher in the group, which received tranexamic acid, and this difference was found to be statistically significant as well (p<0.05). On the contrary, the requirement for blood or blood product transfusions (intraoperative to postoperative day 7) was seen to be higher in the case group, which was also statistically significant (p<0.02). Also, the mean duration of hospital stay post-hysterectomy was shown to be higher in the case group, but the difference was not found to be statistically significant (p<0.09).
Intraoperative blood loss was directly proportional and significant for the weight of the hysterectomy sample obtained and was independent of the use of tranexamic acid, p<0.01. Also, the intraoperative blood loss was seen to be more in the cases operated in general anesthesia than spinal anesthesia. These values were also found to be statistically significant, p<0.04. A correlation was also found between the intraoperative blood loss and the size of the uterus, p<0.01. It was seen that as the size increased, the blood loss increased proportionally, irrespective of the use of TXA.
With respect to the side effects of tranexamic acid, it was shown that the incidence of nausea and vomiting in the case and the control group (7 v/s 0 respectively) and diarrhea (2 and 1 respectively). There was no evidence found of serious adverse effects of tranexamic acid-like visual disturbances, hypotension, or venous thromboembolism.