A survey of gynecologists' utilization of tranexamic acid and factors influencing prophylactic use of tranexamic acid

Background: In the field of gynecology, tranexamic acid (TXA) is an effective therapy for heavy menstrual bleeding (HMB) and can be an intraoperative adjunct for the reduction of surgical bleeding during gynecologic surgery. TXA may be a useful prophylactic treatment to reduce bleeding during hysterectomy and myomectomy, however, its use is not part of routine perioperative guidelines. Few trials have evaluated the benefit of prophylactic TXA in reducing bleeding during gynecologic surgery. Only one study has examined the rate of utilization of TXA by gynecologists during gynecologic surgery. Furthermore, no studies to date have been published investigating the factors influencing use of TXA by gynecologists. The objectives of our study are to determine current practice patterns and utilization of TXA by gynecologists and to examine the factors influencing prophylactic use of TXA. Methods: We conducted a cross-sectional, anonymous, online survey of members of AAGL (formerly known as the American Association of Gynecologic Laparoscopists) which included questions about demographics, practice patterns, and factors influencing use of TXA. Results: A total of 314 AAGL members responded. The majority of respondents (83.8%) reported prescribing oral TXA for HMB. Fifty-eight percent of respondents reported using TXA to treat acute bleeding during gynecologic surgery. TXA was not used in a prophylactic manner for major gynecologic surgery by 57.3% of respondents, whereas 3.82% reported routine use and 38.9% reported selective use of prophylactic TXA for major gynecologic surgeries. Surgeons who completed a minimally invasive gynecologic surgery fellowship were significantly more likely to utilize prophylactic TXA compared to those without fellowship training or other types of fellowship training (45% vs. 34% and 21%; Chi-sq P=0.006). The most common factors influencing the decision to administer prophylactic TXA were uterine/myoma size (91.0%) and preoperative hemoglobin level (72.4%). The most common concerns for using TXA were venous thrombotic events (43.3%) and insufficient evidence-based guidelines (28.7%). Conclusions: TXA use is widespread for treating abnormal menstruation but prophylactic use during gynecologic surgery is less frequent and varies by practice setting and training.