title: A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery.
abstract: BACKGROUND
  The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.
  
  
  OBJECTIVE
  To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.
  
  
  METHODS
  PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.
  
  
  METHODS
  Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.
  
  
  METHODS
  Basic information and outcomes were collected and meta-analyses performed.
  
  
  RESULTS
  Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).
  
  
  CONCLUSIONS
  Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.
authors.affiliation: Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark.
authors.forename: Märta F
authors.initials: MF
authors.lastname: Topsoee
authors.affiliation: Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Settnes
authors.affiliation: Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
authors.affiliation: Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bergholt
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Antifibrinolytic agent; Antifibrinolytic therapy; Bleeding prophylaxis; Obstetric and gynecologic surgery; Surgical bleeding; Tranexamic acid