Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?

Abstract

Background:To assess the efficacy and safety of tranexamic acid (TA) in reducing blood loss and lowering transfusion needs for patients undergoing caesarean section (CS) or vaginal delivery (VD).Methods:An electronic literature search of PubMed, EMBASE, OVID, Cochrane library, Scopus, Central, and Clinical trials.gov was performed to identify studies that evaluating the usage of TA in CS or VD. The methodological quality of included trials was assessed and data extraction was performed.Results:Finally, 25 articles with 4747 participants were included. Our findings indicated TA resulted in a reduced intra-, postoperative, and total blood loss by a mean volume of 141.25 mL (95% confidence interval [CI] −186.72 to −95.79, P < 0.00001), 36.42 mL (95% CI −46.50 to −26.34, P < 0.00001), and 154.25 mL (95% CI −182.04 to −126.47, P < 0.00001) in CS. TA administration in VD was associated with a reduced intra-, postoperative, and total blood loss by a mean volume of 22.88 mL (95% CI −50.54 to 4.77, P = 0.10), 41.24 mL (95% CI −55.50 to −26.98, P < 0.00001), and 84.79 mL (95% CI −109.93 to −59.65, P < 0.00001). In addition, TA could lower the occurrence rate of postpartum hemorrhage (PPH) and severe PPH, and reduce the risk of blood transfusions. No increased risk of deep vein thrombosis (DVT) after CS or VD was associated with TA usage, while the minor side effects were more common.Conclusions:Our findings indicated that intravenous TA for patients undergoing CS was effective and safe. Although prophylactic TA administration is associated with reduced PPH, current existing data are insufficient to draw definitive recommendations about its clinical significance due to the poor to moderate quality of the included literatures. Thus, high-quality randomized controlled trials with larger samples are needed to validate our findings.

The efficiency and efficacy of tranexamic acid in prevention of blood loss during or after caesarean delivery: a comparative study

“…10 Likewise, Li et al found significantly less blood loss during the intra-operative and postoperative periods in patients receiving TXA compared to that of the placebo group. 11 Another study done by Mayur G et al, at Baroda, Gujarat with 100 patients out of which 50 were cases and 50 were control also showed that the tranexamic acid significantly reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum. 12 In this study there was significant difference was noted between the groups regarding changes in hemoglobin (Hb) concentration.…”

Antifibrinolytic therapy for preventing VWD-related postpartum hemorrhage: indications and limitations

“…The insightful hematologist who prescribes TA for bleeding always thinks of this potential risk, although it seems based on numerous studies in surgery and obstetrics and gynecology to be more theoretical than real. 12 Certainly, though, caution has be exercised in states of heightened hypercoagulability such as the peripartum state, but it is reassuring that in the above-mentioned systematic review and metaanalysis 22 there was no observed increase in thromboembolic events nor in an older study of 256 patients with a bleeding disorder treated peripartum with the antifibrinolytic agent aminocaproic acid compared with a control group of 1846 patients. 24 Renal failure was not observed in these studies, but a recent retrospective study of renal cortical necrosis was observed in 18 patients from 5 nephrology units in France over a 4-year period.…”

“…There was a relative risk of 1.74 for minor adverse events with TA for CS in terms of nausea, vomiting, headache, and dizziness. 22 Despite the relatively large number of patients and studies analyzed, the authors of this excellent systematic review and meta-analysis acknowledge the marked heterogeneity in assessing blood loss, dose and duration of TA dosing, use of concurrent uterotonics, and the degree of blinding to mention a few methodological differences in the studies analyzed. Therefore, they appropriately call for further studies as per the Cochrane methodology 22 the studies were judged to be of poor to moderate quality.…”

“…22 Despite the relatively large number of patients and studies analyzed, the authors of this excellent systematic review and meta-analysis acknowledge the marked heterogeneity in assessing blood loss, dose and duration of TA dosing, use of concurrent uterotonics, and the degree of blinding to mention a few methodological differences in the studies analyzed. Therefore, they appropriately call for further studies as per the Cochrane methodology 22 the studies were judged to be of poor to moderate quality. In hopes of higher-quality data, there is an ongoing randomized multicenter French trial of more than 4000 patients undergoing VD and a planned one by the same group in women undergoing CS.…”

“…A recent systematic review and meta-analyses of TA for PPH prevention in women undergoing VD or CS has been reported. 22 This review was composed of 25 randomized studies (22 CS, 3 VD) and involved 4747 participants. Typical dosing of TA was 1 g IV 10 minutes before the CS.…”