Oxytocin and Tranexamic Acid Combination in Laparoscopic Myomectomy: An Innovative Method to Reduce Intraoperative Blood Loss

Myomectomy has been performed mainly through two routes—laparotomy and laparoscopy. Laparoscopy is considered the gold standard. We aim to compare the effect of the combination of intravenous tranexamic acid and oxytocin, with tranexamic acid alone in laparoscopic myomectomy. It was a retrospective study done at a hospital in Kerala, India, from October 2018 to September 2022. At our center, either intravenous tranexamic acid or a combination of intravenous oxytocin and tranexamic acid was administered during laparoscopic myomectomy as a routine practice to reduce blood loss during surgery. We had a total of 150 patients. Out of this, 75 received an intravenous infusion of 1 gm of tranexamic acid and 75 received an intravenous infusion of a combination of 20 units of oxytocin and 1 gm of tranexamic acid. Among the 75 patients who received tranexamic acid alone, 12 had an excessive intraoperative hemorrhage and among the 75 who received a combination of oxytocin and tranexamic acid, seven had excessive blood loss during surgery. The mean duration of surgery in patients who received intravenous tranexamic acid alone was 2 hours 30 minutes ± 18 minutes and in patients who received a combination of oxytocin and tranexamic acid the duration was 1 hour 30 minutes ± 18 minutes. Mean blood loss in patients who received tranexamic acid alone was 300 mL and in those who received a combination of oxytocin and tranexamic acid, it was 150 mL (p-value < 0.001). The mean change in hemoglobin was 0.6 gm% in patients who received tranexamic acid alone and 0.3 gm% in patients who received a combination of oxytocin and tranexamic acid. The mean fall in hematocrit in patients who received tranexamic acid alone was 2.4 and in patients who received a combination of oxytocin and tranexamic acid was 1.2 (p-value < 0.001).