KABERI BEHERA A,RUBA VIKNESH C,DR. E. THULASIRAM
DOI: https://doi.org/Background: Excessive perioperative blood loss in gynaecological surgeries remains an important concern, which often requires blood transfusions that entail risks of infection, immune reactions and higher medical care costs. It has been shown that tranexamic acid (Txa), an antifibrinolytic agent, significantly reduces blood loss and transfusion requirements in various surgical environments. However, the most effective dosing strategy, whether an intravenous bolus dose (IV) or a continuous infusion, is not well established in gynaecological surgeries.
Methods: A unique blind controlled trial was performed in 60 female Patients (ASA I-II), from 18 to 60 years, are subject to optional gynecological surgery in neural anaesthesia. Patients were randomly assigned to get a unique dose of Bolus IV TXA (10 mg/kg) 10 minutes before incision (TXB group) or continuous TXA infusion (1 mg/kg/h) started 10 minutes before incision and stayed and stayed for up to 4 hours after surgery (Grupo TXI). The primary result was the loss of intraoperative blood assessed by standardized blood measurement of soaked mushrooms. Secondary results included the need for blood transfusion, postoperative haemoglobin (HB) and haematocrit and the occurrence of thromboembolic events.
Results: Patients In the TXI group, showed significantly less estimated blood loss compared to the TXB group (p <0.05). Fewer patients in the TXI group required blood transfusions during and after surgery. The HB postoperative levels were higher in the TXI group and no significant differences were observed in thromboembolic complications between groups.
Conclusion: The continuous infusion of Txa seems to be more effective than a single bolus dose to reduce the requirements of perioperative blood loss and transfusion in gynaecological surgeries. These findings support the use of a prolonged antifibrinolytic effect for optimal bleeding control without additional risk of thromboembolic events.
