Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-1, 2017

ISSN: 2454-1362, http://www.onlinejournal.in

Clinical Effect of Tranexamic Acid on

Curing Cervical Erosion
Salwa samir anter
M,D Obstetric Gynecology Cairo University
Abstract: Background Tranexamic acid (TXA) is
competitive inhibitor of plasmin and plasminogen,
hemostatic agent and is orally, locally, or
parenterally administered in surgical procedures or
to treat abnormal uterine bleeding and postpartum
hemorrhage
antifibrinolytic,
antiinflammatory,antiallergy .cervical erosion cause
by columnar epithelium from cervical canal
extending into the vaginal portion of cervix after
infection is brought under control with evidence of
cervicitis is associated with erosion objective. To
evaluate the effectiveness of tranexamic acid
application in treatment of being cervical erosion.
Method.symptomatic patients with being cervix
erosion were divided into test group and control
group with the method of randomized controlled
trial.The patients of test group were treated with
local application of Tranexamic on cervix once a
day.The patients of control group were treated
povidine iodine applied locally on cervix once a
day.The course of treatment was 10-14 d.Resulat
.The curative indexes included the improvement of
symptoms and signs of chronic cervicitis as vaginal
discharge,bleeding on touch and pelvic pain and
healing of erosion which complete after 12 weeks .in
group A symptoms cures in 87%,in group B
symptoms cure in 22% only relief of vaginitist .side
effect of treatment in group A no side effect in group
B vaginal irritation .conclusion.Tranexamic acid
application promising for the treatment of cervical
erosion in symptomatic women it combat symptoms
and sign of chronic cervicitis added to remote
benefits of healing cervix erosion with no side effect
Key word : tranexamic acid cervix erosion

1. Introduction
Cervical erosion is considered to be a physiological
condition caused by columnar epithelium from
cervical canal extending into the vaginal portion of
cervix The prevalence reported for cervical erosion
ranges from 17% to 50% [1-2].It may occur in
adolescence, during pregnancy, or in response to
hormonal contraception [3].Common symptoms
include mucopurulent vaginal discharge, postcoital
bleed-ing, recurrent cervicitis, and pelvic pain.

Imperial Journal of Interdisciplinary Research (IJIR)

Cervical ectopy can also be a risk for infertility after

infection is brought under control, evidence of
cervicitis is associated with ectopia[4]. Cervicitis
may appear as reddish granulation tissue raised
above the surrounding surface, giving the impression
of being papillary. The inflammation and repair
process of cervicitis results in reactive changes,
which are characterized by epithelial disorganization
and nuclear atypia [5]. For chronic cervicitis resistant
to medical treatment, or non infectious cervicitis
including chemical irritation and local trauma,
surgical procedures are required for symptomatic
relief and to avoid development of dysplasia and
neoplasm. Cryocautery, electrocoagulation and laser
therapy are popular methods. These are destructive
procedures. The therapeutic principles of these
therapies the surface of the ablated tissue becomes
crusted, and eventually the trauma is repaired by
reepithelization. Mast cells and chronic cervicitis
Niak et al assessed the association between MC
density and cervical abnormalities. They reported a
decrease in MC in chronic cervicitis with ulceration
and an increase in MC in women with cervical
polyps. Mast cell count was also increased in women
with papillary endocervicitis and chronic cervicitis.
Total MC counts were lower in women with
neoplastic invasion compared with those with
minimal invasion. Mast cell density in neoplastic and
nonneoplastic conditions was increased in the
presence of chronic inflammation, whereas it was
decreased or even absent in carcinoma[6]. in study of
Iddamalgoda A,et al that mast cells are increased in
chronic cervicitis mast cells tryptase degrades type
IV collagen, thus, increased numbers of mast cells
and tryptase might be the cause of weak basement
membranes .-b.[7].mast cells can also induce
vascular proliferation by secreting various
angiogenic factors, such as VEGF, FGF-2,
transforming growth factor-b.[8]. Tranexamic acid
can decrease the activity of mast cells, for example,
mast cell activation after ischaemia and reperfusion
injury is almost completely abolished by TXA
treatment.[9]. also tranexamic acid oral and topical
agents improved epidermal pigmentation and
erythema of melasma. These compounds also
reversed melasma-related dermal changes, such as

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Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-1, 2017
ISSN: 2454-1362, http://www.onlinejournal.in
vessel proliferation and increased numbers of mast
cells .[10].
Tranexamic
acids
trans-4aminomethylcyclohexanecarboxylic acid) is a
medical amino acid a competitive inhibitor of
plasmin and plasminogen, is a hemostatic agent and
is orally, locally, or parenterally administered in
surgical procedures or to treat abnormal uterine
bleeding and postpartum hemorrhage.Plasmin
inhibitors are also used to manage cases of
hemophilia, menorrhagia, von Willebrand syndrome,
disseminated intravascular , and thrombolyticsinduced bleeding.[11-12].Increased plasmin activity
and/or D-dimer levels have been shown to trigger the
release of proinflammatory cytokines such as
interleukin 6 and increase the number of
inflammatory mononuclear cells. [13].Tranexamic
acid decreases plasmin, D-dimer levels, and
inflammatory response.
Plasmin, a trypsin-like
serine protease, promotes intravascular dissolution of
fibrin clots[14-15]. Plasmin can also be produced at
the cell surface as to contribute to the degradation of
extracellular matrix resulting in modulation of tissue
remodeling, cell invasion, and/or metastasis and
chemotaxis. This implies that inhibitors of plasmin
could potentially benefit many other pathologies too
including angioedema, chronic inflammatory
responses,
and
lymphoid
malignancies[1415].Tranexamic acid exhibits anti-allergic and antiinflammatory effects on various skin diseases such as
angioedema anti-inflammatory mechanism appears
to be related to its inhibitory effect on
melanogenesis.[16-17].
The aim of this study was to evaluate the therapeutic
effectiveness of and safety of topical tranexamic
acidic for treatment of cervix erosion

2. Methods
This study conducted in department of Obstetrics
and
Gynecology
at
Diamitte
hospital
(outpatient).After taking written informed consent
from patient prior commencing .A total of 60
pregnant women were enrolled and randomly
assigned into two study groups. Group A Included 30
patients were treated locally with tranexamic acid .
Group B Included 30 patients were treated locally
with povidine iodine. women found to have cervicitis
were provided a course of oral and/or vaginal
antibiotics , and those who were not responsive to
antibiotic treatment were enrolled in study The
inclusion criteria were symptoms vaginal discharge,
postcoital bleeding, pelvic pain and/or other signs
that, if combined, were diagnosed as chronic
cervicitis. All case history were taken included
personal , family history,menstrual history and
obstetrics history previous history of oral
contraception pills ,IUCD,allergic examination
general and local examination the patients were

Imperial Journal of Interdisciplinary Research (IJIR)

seated in the lithotomy position and received

treament, depending on the group to which they were
assigned vaginal secretions and cervical mucus were
carefully removed with cotton swabs erosion site and
size and type were recorde and locally applied with
tranexamic acid solution for 5 minutes The patient
remained in the sitting lithotomy position for 15
minutes repteated every day for 10 days .in group B
povidine iodine were applied locally as in group A
.follow up every week for one month then every
month for 3 months . evaluation of the therapeutic
effect of treatment, cure defined as improvement of
symptoms and signs as vaginal discharge contact
bleeding and healing of erosion .complications &
side-effects were observed & recorded .

3. Resultts
Total 60 patient were diagnosed chronic cervicitis
with erosion not responsible to systemic and local
treatment divided into two groups A tranexamic
group and group B povidine iodine group after
receiving local treatment follow up patients were
reviewed two weeks and four weeks after for
effective of treatment then after 3 month for
complete healing and possible side effect
our results in tranexamic acid group cure rate 87%
after 3month by complete curing of ulcer in povidine
iodine group cure rate 22 % cure with cure only of
vaginal discharge in 50% of cases with no response
to treatment in contact bleeding,recurrent vagnitist,or
pelvic pain .for cure rate of each symptoms,sign in
both group vaginal discharge in group A 30 cases
complain of vaginal discharge 25 cases cure 83% in
group B 30 cases complain of vaginal discharge only
15 cases decreased discharge 50 % as regards contact
bleeding in group A 20 cases complain 20 cases cure
100 %case complain in group B 18 cases complain
of contact bleeding after treatment no case cure,
recurrent vaginitis 16 cases in group A 12 75 %
complete cure in group B 22 cases in group B no
cure , pelvic pain in group A 5 cases cure 5 ingroup
B 8 cases complain no cure .follow up All patients
were reviewed two weeks and four weeks after
treatment Then after 3 month for complete healing
and possible side effect During the course of cervix
recovery, the rate of side effect (including vaginal
reactive discharge was found only in group B
vaginal irritation . There were no complications due
to the tranexamic acid applications during the
follow-up period.

Discussion
The aim of this study was to compare the safety and
efficacy of topical tranexamic acid with topical
povidine iodine in treatment of chronic cervicitis
with erosion In this study, it was shown that the
tranexamic acid effective in treatment of cervical
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Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-1, 2017
ISSN: 2454-1362, http://www.onlinejournal.in
erosion while it is safer .In our study the patients
were diagnosed chronic cervicitis with erosion not
responed to general and local treatment were treated
with tranexamic acid applied local to cervix as local
Treatment has advantage over systemic treatment
that increase its effectiveness and decrease side
effect of treatment in this study antinflammatory
action of tranexamic acid was obvious by improving
symptoms and sign of chronic inflammation this
agree with other studies of antiinflammatory action
of tranexamic acid by different action (1) antiplasmin
action as study of Swedberg, J.E.; et al results that
increased plasmin activity and/or D-dimer levels
have been shown to trigger the release of
proinflammatory cytokines such as interleukin 6 and
increase the number of inflammatory mononuclear
cells.tranexamic acid decreases plasmin, D-dimer
levels, and inflammatory response . [13].( 2)
suppression of marixmetallproteinas in Asato etal
study that inhibition of plasmin attenuates murin
acute graft-verus-host disease mortality by
suppression
the
matrix
metalloproteinase-9dependendent inflammatory and effector cell
trafficking[13](4)inhibition of protease-activated
receptor 2 in study of Shaomin Zhong that Topical
tranexamic acid could improve the epidermal
permeability barrier function and clinical signs of
rosacea, likely resulting from inhibition of PAR-2
activation and consequent calcium influx.
Thus,tranexamic acid could serve as an adjuvant
therapy for rosacea.Rosacea is a common
inflammatory facial disorder with compromised
epidermal permeability barrier function Recent
studies have suggested that protease-activated
receptor 2 (PAR-2) could be involved in the
pathogenesis of rosacea. PAR-2 is a G-proteincoupled 7-transmembrane domain receptor, which
mediates inflammation in various tissues upon
activation by serine proteases [19]. (5) Tranexamic
acid can decrease the activity of mast cells, for
example, mast cell activation after ischaemia and
reperfusion injury is almost completely abolished by
TXA treatment.[9-10] and tranexamic acid also
reversed melasma-related dermal changes, such as
vessel proliferation and increased numbers of mast
cells[20] in other study by Hiramoto K1,a et al,
tranexamic acid decreased the proliferation of mast
cells and increases the proliferation of fibroblasts,
subsequently improving wrinkles caused by skin
dryness. [21]in study of Myoung Shin Kim,et al
,obvious that the treatment of post-inflammatory
hyperpigmentation (PIH) by. tranexamic acid-treated
melanocytes exhibited reduced melanin content and
tyrosinase activity. [21]
Tranexamic acid exhibits anti-allergic and antiinflammatory effects on various skin diseases such as
angioedema anti-inflammatory mechanism appears
to be related to its inhibitory effect on melanogenesis
[16-11].as regards anti allergy .Steven de Maat et al

Imperial Journal of Interdisciplinary Research (IJIR)

study that Plasmin is a natural trigger for bradykinin

production in patients with hereditary angioedema
with factor XII mutations,[23].and other study
byBouillet L etal.When a non-histaminergic
angioedema is suspected, tranexamic acid must be
proposed as attack's treatment and as prophylactic
treatment r [25]. .Asero R.a et al,Heparin and
Tranexamic Acid Therapy May Be Effective in
Treatment-Resistant Chronic Urticaria with Elevated
D-Dimer [25].
Healing of erosion agree with previous studies of
healing capacity of tranexamic by affects either (1)
growth factor as in study of Felipe Antonio
SOBRAL et al ,in the experimental model using
tranexamic acid has shown to be effective in hepatic
regeneration during longer periods of observation
after partial hepatectomy. [26]it seems possible that
tranexamic acid acts changing the levels of growth
factors and inhibition factors. [27].Based on this
knowledge,
One to two hours after partial
hepatectomy, it occurs an increase in mitotic growth
factors such as HGF (hepatocyte growth factor),
which is the most potential mitotic factor, reaching
20 times higher values than those presented before
surgery [28].Three to four days after hepatectomy,
the mitotic rate of liver cells is very reduced due to
the appearance inhibitors growth factors such as
TGF-1 (transforming growth factor-1), which is
regarded as the signal of the end of the hepatic
regeneration. [29].in this period, the liver must have
reached almost its original volume. Others study of
role of tranexamic acid and growth factor by
Fernandez-L to et al,study Therapeutic action of
tranexamic acid in hereditary haemorrhagic
telangiectasia oral administration of tranexamic acid
A proved beneficial for epistaxis treatment in
selected patients with HHT. In addition to its already
reported antifibrinolytic effects, tranexamic acid
stimulates the expression ofALK-1 and endoglin, as
well as the activity of the ALK-1/endoglin pathway
[30].as regards platelet and tranexamic acid, platelets
initiating wound repair by releasing locally acting
growth factors a -granules degranulation .[31]Van
Aelbrouck, study, TXA administration seems to
improve platelet function in patients that did not
received preoperative aspirin. Although, this
beneficial effect was not observed in the presence of
aspirin[32].Tranexamic acid partially improves
platelet function in patients treated with dual
antiplatelet therapy in study of Weber CF1, [33].
Tranexamic acid and occudin,occludin plays an
important role in the tight junctions (TJ), it is not
surprising that a range of diseases are associated with
disruption of the TJ and alterations in regulation of
occludin. These diseases include diarrhea ,
inflammatory diseases such as inflammatory bowel
disease, multiple sclerosis, cancer, diabetes and
allergic disorders. Strategies to prevent and/or
occludin downregulation in such diseases could lead
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Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-1, 2017
ISSN: 2454-1362, http://www.onlinejournal.in
to novel and effective future therapeutic options .
[34].in study of Chao Yuan that Tranexamic acid
accelerates skin barrier recovery and upregulates
occludin in damaged skin [35].tranexamic acid and
fibronectin. Fibronectin serves as a primary adhesive
component in the healing process and anchors
regenerating epithelial cells to underlying stroma
tranexamic acid inhibit the activation of plasmin
thereby decreasing plasmin-induced catabolism of
fibronectin.so Regnier A1 et al, were studies topical
treatment of non-healing corneal epithelial ulcers in
dogs with aminocaproic acid [36].also,.in study of
Crouch E R,etal..aminocaproic acid and tranexamic
acid increase the rate of acute corneal
repithelialization in Sprague Dawley rats.[37].Bjrlin
G1, et al, is clear from this investigation that, unlike
epsilon-aminocaproic acid, tranexamic acid has a
positive effect on wound healing, and that this effect
is not due to the antifibrinolytic properties, as both
are powerful fibrinolytic inhibitors.[38].Tranexamic
acid And Healing stress ulcer Kodama Y, results
indicate that antifibrinolytic agents may be beneficial
in the prevention of stress ulcers in man and support
the concept that local gastric fibrinolysis may play a
role in the pathogenesis [39].

4. CONCLUSION
The efficacy of tranexamic acid for treatment
chronic cervicitis and erosion has been confirmed.
This comparative study demonstrated: (i) the
therapeutic efficacy of tranexamic acid onlys while
povidine iodine improve only vaginal discharge (ii)
no side effects in tranexamic acid treatment but in
povidine iodine vaginal irritation . In conclusion,
tranexamic acid can treat symptomatic erosion of the
cervix with no side effect

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Imperial Journal of Interdisciplinary Research (IJIR)

Vol-3, Issue-1, 2017
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