Tranexamic Acid in Vaginal Reconstructive Surgery
- Conditions
- Pelvic Organ Prolapse
- Interventions
- Registration Number
- NCT06419075
- Brief Summary
Tranexamic acid (TXA) has been demonstrated to reduce blood loss in trauma, orthopedic, cardiac, and plastic surgeries in numerous well-designed and adequately powered studies. As a result of this evidence for benefit, TXA is routinely used to reduce blood loss during these surgeries. There are no studies regarding the use of TXA in urogynecology. The investigators seek to explore the effect and safety of local infiltration of TXA in vaginal reconstructive surgery.
- Detailed Description
This is a multicenter, double blinded, pilot randomized clinical trial that will be conducted at UTMB Health, and other participating sites. Each participating site will obtain IRB approval. Women with symptomatic, stage II to IV Pelvic organ prolapse (POP) who plan colpocleisis will be approached to participate. Using the study protocol inclusion and exclusion criteria, patient's eligibility will be determined. All eligible subjects will provide the written informed consent before any research data is collected. All screening assessment will be completed at a preoperative, in-person, clinic visit, and within 60 days of surgery. The subject will then undergo randomization to the local TXA, or Vasopressin, or NS group with the total sample size of 36 female subjects (12 per group). Concomitant procedures for POP or urinary incontinence are permitted and will be based upon the operating surgeons' standard clinical practice and best clinical judgement. The anesthesia team is responsible for preparing the study agents, monitoring intraoperative cardiovascular parameters (blood pressure and heart rate) as well as adverse events, and determining the blood transfusion if needed. Subsequently, the subject will have postoperative follow up at 2 weeks and 6 weeks
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- Female
- Target Recruitment
- 36
- Females who are menopausal at the time of consent
- Able to understand and read English
- Able and willing to provide written informed consent
- Able to comply with the follow-up study protocol, per clinician judgment
- Symptomatic POP (bulge or pressure) evidenced with vaginal prolapse with POP-Q measurement consistent with Stage II-IV
- LeFort or complete colpocleisis as desired surgical approach to correct POP with and without other concomitant procedures
- History of abdominal or vaginal surgery for POP
- American Society of Anesthesiologists (ASA) physical status I or II
- Texas Department of Criminal Justice prisoners
- Refusal of blood products (e.g, Jehovah's witnesses)
- ASA physical status III or IV
- Known allergy or hypersensitivity to TXA or any of the ingredients
- Subarachnoid hemorrhage
- Active intravascular clotting, thromboembolic disease (cerebral thrombosis, deep vein thrombosis, or pulmonary embolism)
- Epilepsy, seizure disorders requiring anti-epileptic medication(s)
- Acquired impaired color vision (color blindness, retinal involvement)
- Intrinsic risk of thrombosis or thromboembolism (hypercoagulopathy, thrombogenic cardiac rhythm disease, thrombogenic valvular disease)
- History of severe liver disease
- Known allergy or hypersensitivity to 8-L-arginine vasopressin or chlorobutanol
- History of cardiac diseases (decompensated congestive heart failure CHF, recent coronary artery disease CAD within 30 days, recent myocardial infarction MI within 30 days)
- History of reversible nephrogenic diabetes insipidus
- History of primary pelvic organ cancer (uterine, ovarian, endometrial, cervical, bladder) or any cancer that is metastatic to the pelvis
- Prior or current pelvic radiation, or chemotherapy.
- Females who desires to have vaginal sexual intercourse after the surgery
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Normal Saline (NaCl 0.9%) NaCl 0.9% Local infiltration of 50 cc NaCl 0.9% into the vaginal submucosa during colpocleisis dissection Tranexamic Acid (2 mg/dL) Tranexamic acid Local infiltration of 50 cc Tranexamic Acid (2 mg/dL) into the vaginal submucosa during colpocleisis dissection Vasopressin (0.1 U/dL) Vasopressin Local infiltration of 50 cc Vasopressin (0.1 U/dL) into the vaginal submucosa during colpocleisis dissection
- Primary Outcome Measures
Name Time Method Intraoperative quantitative blood loss QBL (mL) Intraoperatively Compare intraoperative QBL during colpocleisis with the local infiltration of Tranexamic acid to the current standard of care, vasopressin or normal saline.
- Secondary Outcome Measures
Name Time Method Intraoperative hear rate (beats/min) Intraoperatively Evaluate the effect on heart rate at 1, 5, and 10 mins after the local infiltration of Tranexamic acid, vasopressin and NS into the vaginal mucosa.
Rate of transfusion Intraoperatively and 2 weeks postoperatively Quantify the need for blood-product transfusion and the volume administered as a direct result of colpocleisis, either intraoperative or postoperative
Colpocleisis operative time (min) Intraoperatively Compare the colpocleisis operative time between Tranexamic acid, vasopressin or normal saline groups
Postoperative complications 2 weeks and 6 weeks postoperatively Assess postoperative complications following colpocleisis using the Clavien-Dindo Classification (CDC) categories
Intraoperative blood pressure (mmHg) Intraoperatively Evaluate the effect blood pressures at 1, 5, and 10 mins after the local infiltration of Tranexamic acid, vasopressin and NS into the vaginal mucosa.
Trial Locations
- Locations (1)
University of Texas Medical Branch Galveston
🇺🇸Galveston, Texas, United States