Martin-Hirsch, P.P.L., and Bryant, A. (2013). Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews, 2013, CD001421. 

STUDY PURPOSE: To assess safety and efficacy of interventions used to prevent blood loss during treatment of cervical intraepithelial neoplasia (CIN)

TYPE OF STUDY: Meta-analysis and systematic review

PHASE OF CARE: Active antitumor treatment

• Vasopressin versus placebo: One trial showed significant reduction in blood loss (MD -100.9, p < 0.00001). One trial examined selective bleeding and showed a significant reduction with vasopressin (RR = 0.4, p < 0.0001)
• Tranexamic acid (TA) versus placebo: One trial showed reduction in postoperative blood loss with TA (MD -55.6, p < 0.0001). Analysis of two trials showed no meaningful difference in the risk of primary hemorrhage (RR = 1.24), and across four trials, there was significantly reduced risk of secondary hemorrhage with TA (RR = 0.23, p = 0.00017).
• Vaginal pack with Monsel’s solution: Vaginal packs were associated with significant reduction in perioperative blood loss and decreased risk of dysmennorhea compared with hemostatic sutures (p < 0.05).

Vasopressin, TA, and vaginal packs with Monsel’s solution appear to be helpful in reducing blood loss in women with CIN undergoing surgical procedures. Findings are limited because few studies exist comparing specific interventions.

• Limited number of studies included
• Mostly low quality/high risk of bias studies

This review contains limited evidence; however, findings suggest that use of vasopressin, TA, and vaginal packs with Monsel’s solution may be helpful to reduce various types of procedure-related bleeding in women with CIN.