Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: a systematic review and meta-analysis of 11 controlled trials
Alomar O, Abu-Zaid A, Jamjoom MZ, Almubarki AA, Alsehaimi SO, Alabdrabalamir S, Baradwan S, Abuzaid M, Alshahrani MS, Khadawardi K, et al
Journal of gynecology obstetrics and human reproduction. 2022;:102485
OBJECTIVE To collate evidence from randomized controlled trials (RCTs) and nonrandomized controlled trials (NCTs) on the efficacy and safety of vasopressin versus passive control (placebo/no treatment) during myomectomy. METHODS Six information sources were screened until 25-June-2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias. Data were summarized as mean difference or risk ratio with 95% confidence interval in a random-effects model. RESULTS Eleven studies, comprising 1067 patients (vasopressin=567 and control=500) were analyzed. For RCTs (n=8), the overall quality included 'high risk' (n=4), 'low risk' (n=2), and 'some concerns' (n=2). For NCTs (n=3), the overall quality included 'good' (n=2) and 'fair' (n=1). The mean intraoperative blood loss, mean difference in hemoglobin level, mean difference in hematocrit level, rate of perioperative blood transfusion, and mean operative time were significantly reduced in favor of the vasopressin group compared with the control group. However, there was no significant difference between both groups regarding the mean hospital stay. Pertaining to safety endpoints, after omission of an outlier study, the rate of drug-related cardiovascular adverse events did not significantly differ between both groups. There was no quantitative evidence of publication bias for the endpoint of intraoperative blood loss. CONCLUSION Among patients undergoing myomectomy, prophylactic administration of vasopressin was largely safe and correlated with significant reductions in intraoperative blood loss and associated morbidities compared with a passive control intervention. Nonetheless, the conclusions should be cautiously interpreted owing to the low-evidence quality and the used doses varied greatly between studies.
Value of intrauterine platelet-rich concentrates in patients with intrauterine adhesions after hysteroscopy: A systematic review and meta-analysis of randomized controlled trials
Korany S, Baradwan S, Badghish E, Talat Miski N, Alshahrani MS, Khadawardi K, Baradwan A, Alanwar A, Labib K, Dahi AA, et al
European journal of obstetrics, gynecology, and reproductive biology. 2022;271:63-70
OBJECTIVE To evaluate the value of intrauterine platelet-rich concentrates among patients with intrauterine adhesions (IUAs) after hysteroscopic adhesiolysis. METHODS Four different databases (PubMed, Cochrane Library, Scopus, and ISI web of science) were searched for the available studies from inception to November 2021. We selected randomized clinical trials (RCTs) that compared platelet-rich concentrates in the intervention group versus no injection of platelet-rich concentrates in the control group among women with intrauterine adhesions after operative hysteroscopy. Revman software was utilized for performing our meta-analysis. Our primary outcomes were the adhesion score and incidence of recurrence of severe intrauterine adhesions postoperatively. Our secondary outcomes were the clinical pregnancy rate, menstrual flow duration in days, and menstrual flow amount (number of pads). RESULTS Five RCTs met our inclusion criteria with a total number of 329 patients. We found that platelet-rich concentrates were linked to a significant reduction in the postoperative adhesion score (MD = -1.00, 95% CI [-1.68, -0.32], p = 0.004). Moreover, there was a significant reduction in the incidence of severe IUAs recurrence among the platelet-rich concentrates group (7.6%) compared to the control group (23.4%) after hysteroscopy (p = 0.001). The clinical pregnancy rate was significantly increased among the platelet-rich concentrates group (37.1%) in comparison with the control group (20.7%) after hysteroscopic adhesiolysis (p = 0.008). There were significant improvements in the menstrual flow duration and amount among the platelet-rich concentrates group (p < 0.001). CONCLUSIONS Intrauterine placement of platelet-rich concentrates is an effective method for the treatment of intrauterine adhesions after hysteroscopy.
Prophylactic tranexamic acid among women undergoing vaginal delivery to reduce postpartum blood loss and related morbidities: a systematic review and meta-analysis of 17 randomized controlled trials
Abu-Zaid A, Baradwan S, Alshahrani MS, Bakhsh H, Badghish E, Khadawardi K, AlRasheed MA, Turkistani A, AlNaim NF, AlNaim LF, et al
Journal of gynecology obstetrics and human reproduction. 2022;:102378
OBJECTIVE To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that inspected the efficacy and safety of prophylactic TXA compared with control (placebo/no treatment) among women undergoing vaginal delivery on reducing postpartum blood loss and related morbidities. METHODS Six databases were screened from inception until 06-December-2021. The pooled data were summarized as mean difference or risk ratio, respectively, with 95% confidence interval in a fixed- or random-effects model. RESULTS Sixteen studies comprising 17 RCT treatment arms were included. There were 7075 patients; 3548 and 2537 patients were allocated to prophylactic TXA and control groups, respectively. Overall, the included RCTs had a low risk of bias. Prophylactic TXA correlated with a significant decrease in mean postpartum blood loss and mean change in hemoglobin/hematocrit. Moreover, prophylactic TXA was linked to decreased incidence rates of postpartum hemorrhage, need for blood transfusion, and need for additional uterotonic agents. Nevertheless, prophylactic TXA culminated in significantly higher incidence rates of nausea, vomiting, and diarrhea, all of which were well-tolerated. There was no increased risk of thromboembolic events. Leave-one-out sensitivity analysis confirmed the robustness of efficacy endpoints. There was no publication bias for the endpoint of mean postpartum blood loss. CONCLUSION Among patients undergoing vaginal delivery, prophylactic TXA during active management of third stage of labor (AMTSL) appeared largely safe and correlated with a significant decrease in postpartum blood loss and related morbidities compared with control intervention. Prophylactic TXA should be integrated as a "formal" component of AMTSL among women undergoing vaginal delivery.
Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials
Baradwan S, Hafidh B, Latifah HM, Gari A, Sabban H, Abduljabbar HH, Tawfiq A, Hakeem GF, Alkaff A, AlSghan R, et al
European journal of obstetrics, gynecology, and reproductive biology. 2022;276:82-91
OBJECTIVE To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy. METHODS Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model. RESULTS Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03). CONCLUSION Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities.
Vasopressin to control blood loss during hysterectomy: a systematic review and meta-analysis of randomized controlled trials
Hafidh B, Latifah HM, Gari A, Alshahrani MS, AlSghan R, Alkhamis WH, Allam HS, AlRasheed MA, Bakhsh H, Abu-Zaid A, et al
Journal of minimally invasive gynecology. 2021
OBJECTIVE Minimizing intraoperative blood loss during hysterectomy is crucial to lessen associated perioperative morbidity. The aim of this investigation is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared vasopressin versus normal saline in controlling intraoperative blood loss during hysterectomy. DATA SOURCES We screened five major databases (PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials) from inception till July 18, 2021. We used the following query search in all databases: (vasopressin OR arginine vasopressin OR argipressin OR antidiuretic hormone) AND (hysterectomy) AND (saline OR placebo OR control OR no treatment) AND (randomized OR randomised OR randomly). There was no language restriction during database screening. METHODS OF STUDY SELECTION We considered all studies that met the following evidence-based criteria: (i) Patients: individuals undergoing hysterectomy for any indication, (ii) Intervention: vasopressin, (iii) Comparator: normal saline, placebo, or no treatment, (iv) Outcomes: reliable extraction of any of our endpoints, and (v) Study design: RCTs. We assessed risk of bias of included studies and pooled endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). We performed statistical analysis using the Review Manager software, version 5.4.0. TABULATION, INTEGRATION, AND RESULTS Seven RCTs with an overall low risk of bias met the inclusion criteria. This meta-analysis included a total of 455 patients; 232 and 223 patients were allocated to vasopressin and control group, respectively. The majority of RCTs were vaginal hysterectomy (n=5) with few abdominal hysterectomy (n=2) and no laparoscopic hysterectomy. The mean estimated intraoperative blood loss was significantly lower in favor of the vasopressin group compared with the control group (n=6 RCTs, MD=-119.85 ml, 95% CI [-177.55, -62.14], p<0.001). However, there was no significant difference between both groups regarding mean operating time, mean change in postoperative hemoglobin, mean hospital stay, rate of febrile morbidity, rate of pelvic infection, rate of perioperative blood transfusion, and rate of perioperative complications. CONCLUSION Compared with normal saline, vasopressin significantly reduced the estimated blood loss during hysterectomy, but did not change any clinically significant outcomes. Additionally, vasopressin was safe and did not correlate with an increase in the rates of febrile morbidity or pelvic infection.