Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: a systematic review and meta-analysis of 11 controlled trials - 12/10/22

Doi : 10.1016/j.jogoh.2022.102485

Osama Alomar ^a,^b,^{^{#
Both authors contributed equally to the work}}, Ahmed Abu-Zaid ^a,^c,^⁎,^{^{#
Both authors contributed equally to the work}} , Mohammed Ziad Jamjoom ^d, Abdullah AMA Almubarki ^e, Saud Owaimer Alsehaimi ^b, Safa Alabdrabalamir ^f, Saeed Baradwan ^g, Mohammed Abuzaid ^h, Majed Saeed Alshahrani ⁱ, Khalid Khadawardi ^j, Ehab Badghish ^k, Hanadi Bakhsh ^l, Maha Al Baalharith ^m, Ibtihal Abdulaziz Bukhari ^l, Afnan Baradwan ⁿ, Hany Salem ^a,^b, Ismail A. Al-Badawi ^a,^b
^a Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia
^b Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
^c College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
^d Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
^e Department of Obstetrics and Gynecology, Farwaniya Hospital, Al-Farwaniyah, Kuwait
^f Riyadh Second Health Cluster, Riyadh, Saudi Arabia
^g Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
^h Department of Obstetrics and Gynecology, Muhayl General Hospital, Muhayl, Saudi Arabia
ⁱ Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
^j Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
^k Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah, Saudi Arabia
^l Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
^m Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
ⁿ Department of Obstetrics and Gynecology, New Jeddah Clinic Hospital, Jeddah, Saudi Arabia

^⁎Corresponding Author: Ahmed Abu-Zaid, MBBS, PhD (c); College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA; Telephone number: +1(901)-283-4596; Fax number: +1(901)-448-5052College of Graduate Health Sciences, University of Tennessee Health Science CenterMemphisTennessee38163USA

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ABSTRACT

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.

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KEYWORDS : Leiomyoma, vasopressin, myomectomy, blood, bleeding, meta-analysis