Intravenous Tranexamic Acid Combined With Intramyometrial Desmopressin During Laparoscopic Myomectomy: A Randomized Double-Blind Placebo-Controlled Trial

Abstract

Objective: To evaluate whether intravenous tranexamic acid combined with intramyometrial desmopressin reduces perioperative blood loss during laparoscopic myomectomy. Design: A prospective, randomized, double-blind, placebo-controlled trial. Setting: A tertiary university hospital. Patients: One hundred women undergoing laparoscopic myomectomy for symptomatic uterine fibroids were included in the anticoagulant use, body mass index >= 30 kg/m2, or concomitant surgical procedures were excluded. Interventions: Participants were randomized to receive intravenous tranexamic acid 1 g (n = 50) or placebo (normal saline; n = 50). All patients received intramyometrial desmopressin (30 mcg diluted in 100 mL normal saline). Measurements and Main Results: Median estimated blood loss did not differ significantly between the tranexamic acid and placebo groups (150 mL vs 100 mL; p = .269). Transfusion rates were similar (10% vs 6%; p = .715). Postoperative hemoglobin levels were comparable between groups (p = .505). Surgeon-rated operative difficulty scores were significantly higher in Group I than in Group II (median score: 6 vs 5, p = .016). Multivariable regression identified myoma number (B = 19.09 mL per myoma; 95% CI: 8.31-29.86; p = .001) and myoma diameter (B = 2.02 mL per cm; 95% CI: 0.18 -3.85; p = .032) as independent predictors of blood loss. Increasing age was independently associated with blood transfuConclusion: Tranexamic acid was safe but did not significantly reduce estimated blood loss or the need for transfusion compared with the placebo. Routine combined use is not supported; however, further evaluation in patients with a higher myoma burden may be warranted. Journal of Minimally Invasive Gynecology (2026) 33, 1473-1480.