Prophylactic Tranexamic Acid to Reduce Excess Blood Loss During Dilation and Evacuation: A Pilot Study [ID 1119]

INTRODUCTION: Although commonly used, no study has examined prophylactic tranexamic acid (TXA) to reduce excess bleeding at the time of dilation and evacuation (D&E). In this pilot study, we sought to estimate whether prophylactic use of intravenous TXA decreases the frequency of interventions to control excess blood loss during D&E. Disclosure: TXA was used in this study off-label. METHODS: In this randomized, double-blind, placebo-controlled pilot trial, participants undergoing D&E at 16–24 weeks of gestation received 1 g of TXA in 100 mL of intravenous fluid or 100 mL of intravenous fluid alone at the time of procedure. Primary outcome was frequency of interventions to control excess bleeding. A sample size of 74 participants per group was needed to demonstrate a 13% difference in intervention with 80% power and two-sided α of 0.05. For the pilot, we enrolled 30% of this sample plus an additional 10% to account for participant dropout. RESULTS: From February 2022 to August 2023, 50 participants were enrolled and randomized (25 in the TXA group, 25 in the placebo group). Three participants had post-randomization exclusions (1 in TXA group, 2 in placebo). Of patients in the placebo group, 75% (n=18) received interventions for bleeding compared with 65% (n=15) in the TXA group ( P =.46). Bimanual uterine massage and uterotonics were the most common interventions. CONCLUSIONS/IMPLICATIONS: This pilot study suggests participants prophylactically administered TXA during D&E at 16–24 weeks required similar interventions to control bleeding as those administered a placebo. A larger study with adequate power to detect significant difference is warranted.