Efficacy of Prophylactic Intravenous Tranexamic Acid in Minimizing Hemorrhage during Open Myomectomy for Multiple Uterine Myomas

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 963–974

DOI: 10.46882/2026/IJOG/000561

Original Research Article

Title: Efficacy of Prophylactic Intravenous Tranexamic Acid in Minimizing Hemorrhage during Open Myomectomy for Multiple Uterine Myomas

Names of Authors: Mateo Fernandez¹, David Goldstein²

Authors’ Affiliations:
¹ Departamento de Obstetricia y Ginecología, Hospital Clínic de Barcelona, Barcelona, Spain
² Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Abstract:
Abdominal myomectomy for multiple large uterine leiomyomas carries an inherent risk of massive intraoperative blood loss, frequently necessitating emergency red blood cell transfusions. This double-blind, placebo-controlled randomized clinical trial investigated the hemostatic efficacy and safety of prophylactic intravenous Tranexamic Acid (TXA) administration in limiting surgical bleeding. One hundred and forty premenopausal women undergoing open abdominal myomectomy for the removal of at least four uterine fibroids (uterine volume equivalent to ≥ 14 weeks) were randomized to receive either 1 g of intravenous TXA (n = 70) or a matching 0.9% saline placebo (n = 70) slowly 20 minutes prior to skin incision. The primary endpoint evaluated was total intraoperative and postoperative blood loss calculated via gravimetric and hemometatric parameters. The mean total calculated blood loss was significantly lower in the TXA cohort compared to the placebo cohort (312.5 ± 85.4 mL vs. 495.6 ± 132.8 mL, p < 0.001). Postoperative hemoglobin drop evaluated 24 hours after surgery was also significantly smaller in the TXA group (0.68 ± 0.22 g/dL vs. 1.25 ± 0.42 g/dL, p < 0.001). Homologous blood transfusion was required for only 1.4% of the TXA group compared to 10.0% of the placebo group (p = 0.028). No thrombotic adverse events occurred within 6 weeks post-surgery. Prophylactic administration of tranexamic acid significantly limits surgical blood loss and minimizes transfusion dependencies during extensive open myomectomy procedures.

Keywords: Tranexamic Acid; Abdominal Myomectomy; Uterine Fibroids; Surgical Hemorrhage; Hemoglobin Drop; Hemostasis.

Manuscript Timeline: Received: June 22, 2026; Revised: August 18, 2026; Accepted: September 06, 2026; Published: September 12, 2026.

Citation: Fernandez M, Goldstein D. Efficacy of Prophylactic Intravenous Tranexamic Acid in Minimizing Hemorrhage during Open Myomectomy for Multiple Uterine Myomas. International Journal of Obstetrics and Gynecology. 2026; 14(9): 963–974.

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