Tranexamic acid for the management of uterine fibroid tumors: A systematic review of the current evidence

Table 1 Summary of the selected studies

Ref.	Country	Type of study	Meanage	Symptom-atology	Participants	Aim of thestudy	Regimenadministration	Results	Adverse effects	Comment
Lakhani et al[10]	United Kingdom	Longitudinal Prospective	42.8	Menorrhagia Pelvic pain	n = 12	Ultrasound assesment of PI and RI of UA in women with TA administration	Tranexamic acid P.O. 1 g x 3 for 2 cycles	No significant changes in blood loss or PI and RI	Not reported	No changes in UA-PI resistance in women with fibroids
Caglar et al[11]	Turkey	Prospective randomized double-blind placebo	34.2	Menorrhagia Pelvic pain	n = 50 (TA) n = 50 (Placebo)	To compare the perioperative blood loss in patients undergoing myomectomy and taking TA with patients not taking TA	Tranexamic acid 10 mg/kg iv (max 1 g) 15 min before incision	Significant statistical differences in two groups postoperative, total blood loss and duration of surgery (P < 0.01) in favor of TA	Not reported	TA does not reduce perioperative blood loss nor Hb levels. It reduces postoperative and total blood loss and surgery time in correlation with myoma size. However further investigations required
Ip et al[12]	Hong Kong	Observational	43.8 ± 25	Menorrhagia Pelvic pain	n = 22	Pathology assesment of fibroid specimen in women receiving TA	Tranexamic acid Per os dosage not reported	Necrosis and infarcts in resected fibroids. Larger daimeter fibroids more prone to necrosis changes. Size is an independent factor	Not reported	Authors emphasize the necrosis and thrombosis in fibroids but suggest precaution for complications
Lukes et al[14]	United States	Randomized double-blind placebo	36.5	Menorrhagia Pelvic pain	n = 42 (TA) n = 26 (Placebo)	To assess the efficacy and safety of TA for heavy menstrual bleeding	Tranexamic acid Per os 1.3 g daily for 5 d up to 6 cycles	Reduction in menstrual blood loss in women receiving TA compared to placebo. No statistically significant changes in blood loss in patients with fibroids	Mild adverse effects Menstrual cramps Gastrointestinal allergies	TA was effective in the treatment of heavy menstrual bleeding regardless of the presence or absence of fibroids
Eder et al[13]	United States	Randomized double-blind placebo	38	Menorrhagia Pelvic pain	n = 96 (TA) n = 51 (Placebo)	To compare the menstrual blood loss in women with fibroids and TA and women with fibroids not taking TA. consisting placebo group	Tranexamic acid Per os 3.9 g/d for 5 d up to 6 menstrual cycles	Menstrual blood loss reduced in women receiving TA (P < 0.001)	3 patients in TA group and 3 in placebo group reported headache	TA was well tolerated and reduced menstrual blood loss

TA: Tranexamic acid; UA: Umbillical artery; UA-PI: Umbillical artery pulsatility index.

Table 2 Quality assessment of the studies according to Scottish Intercollegiate Guidelines Network guidelines

Ref.	Setting	Sign grade	Interpretation
Lakhani et al[10] 1998	University teaching hospital	2+	Well conducted study
Caglar et al[11] 2007	University teaching hospital	2++	High quality study
Ip et al[12] 2007	University teaching hospital	2+	Well conducted study
Lukes et al[14] 2010	University teaching hospital	2++	High quality study
Eder et al[13] 2013	Private research institution and University teaching hospital	2++	High quality study