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. 2025 Jun 11:12:1590144.
doi: 10.3389/fmed.2025.1590144. eCollection 2025.

A meta-analysis of randomized controlled trials examining the effectiveness of carbetocin in reducing intraoperative blood loss during abdominal myomectomy

Ahmed Abu-Zaid  1 , Saeed Baradwan  2 , Bandr Hafedh  2 , Majed Saeed Alshahrani  3 , Maha Al Baalharith  4 , Ehab Badghish  5 , Fahad Algreisi  6 , Mohammed Ziad Jamjoom  7 , Saad M S Alqarni  8 , Hedaya Albelwi  9 , Ahmed Nazer  10 , Afnan Baradwan  11 , Saud Owaimer Alsehaimi  10 , Mohannad Alsabban  10 , Osama Alomar  1   10
Affiliations

A meta-analysis of randomized controlled trials examining the effectiveness of carbetocin in reducing intraoperative blood loss during abdominal myomectomy

Ahmed Abu-Zaid et al. Front Med (Lausanne). .

Abstract

Aim: This study aimed to systematically review and meta-analyze randomized controlled trials (RCTs) assessing the clinical efficacy and safety of carbetocin compared to passive control (placebo or no treatment) in the context of abdominal myomectomy.

Methods: Six sources of information underwent screening until 13 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean difference (MD) or risk ratio (RR) along with a 95% confidence interval (CI) using a random-effects model.

Results: Five RCTs with 6 arms and 484 patients (carbetocin = 262 and control = 222) were analyzed. The overall risk of bias was "low" in two studies and "some concerns" in three studies. The carbetocin group exhibited significantly lower mean intraoperative blood loss (n = 6 arms, MD = -292.27 mL, 95% CI [-372.5, -212.03], p < 0.001, with very low certainty of evidence), mean change in hemoglobin (n = 6 arms, MD = -0.63 g/dL, 95% CI [-0.94, -0.33], p < 0.001, with low certainty of evidence), rate of blood transfusion (RR = 0.3, 95% CI [0.21, 0.44], p < 0.001, with very low certainty of evidence), and mean operation time (n = 5 arms, MD = -22.98 min, 95% CI [-38.93, -7.02], p < 0.001, with low certainty of evidence). There was no significant difference between both groups regarding the mean hospital stay (n = 2 arms, MD = -0.1 days, 95% CI [-0.27, 0.06], p = 0.21). The sensitivity analyses demonstrated robustness across all outcomes. No major toxicities were reported.

Conclusion: Carbetocin use was tolerable and associated with considerable declines in intraoperative blood loss and related complications compared with passive control intervention during abdominal myomectomy.

Keywords: bleeding; carbetocin; leiomyoma; meta-analysis; myomectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart for literature search and study selection.
Figure 2
Figure 2
Summary of the risk of bias of the included studies.
Figure 3
Figure 3
Meta-analysis of the endpoints: (A) mean intraoperative blood loss (ml), (B) mean change in hemoglobin (g/dl), (C) rate of blood transfusion (%), (D) mean operative time (mins), and (E) mean length of hospital stay (days).
Figure 4
Figure 4
Leave-one-out sensitivity analysis of the endpoints: (A) mean intraoperative blood loss (ml), (B) mean change in hemoglobin (g/dl), (C) rate of blood transfusion (%), (D) mean operative time (mins), and (E) mean length of hospital stay (days).
Figure 5
Figure 5
Subgroup analysis based on the route of drug administration (intravenous vs. intramyometrial) for the heterogeneous endpoints: (A) mean intraoperative blood loss (ml) and (B) mean operative time (mins).
Figure 6
Figure 6
Funnel plot for publication bias assessment of the endpoints: (A) mean intraoperative blood loss (ml), (B) mean change in hemoglobin (g/dl), (C) rate of blood transfusion (%), (D) mean operative time (mins), and (E) mean length of hospital stay (days).
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