Prophylactic tranexamic acid among women undergoing vaginal delivery to reduce postpartum blood loss and related morbidities: A systematic review and meta-analysis of 17 randomized controlled trials

Abu‐Zaid, Ahmed; Baradwan, Saeed; Alshahrani, Majed Saeed; Bakhsh, Hanadi; Badghish, Ehab; Khadawardi, Khalid; AlRasheed, May A; Turkistani, Abdulrhman; AlNaim, Nora F; AlNaim, Latifa F; Fodaneel, Meshael; AbuAlsaud, Fatimah Shakir; Jamjoom, Mohammed Ziad; Tulbah, Maha; Almugbel, Maisoon; Alomar, Osama; Al-Jundi, Haifa; Allam, Hassan; Alabdrabalamir, Safa; Salem, Hany; Al‐Badawi, Ismail A.

doi:10.1016/j.jogoh.2022.102378

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…The onset in vivo can only be maintained for a few hours, mainly by inhibiting fibrinolysis at the surgical site to stabilize the formed blood clot to achieve the purpose of rapid hemostasis, and will not promote the formation of new thrombosis. 250 cases in patients undergoing initial spinal surgery, TXA 1 g was intravenously administered intraoperatively [ 11 ]. After 3 months of follow-up, there was no statistically significant difference in the incidence of DVT and PE between the TXA group and the control group.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

Bao

Lü

Gao

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. The safety and effectiveness of topical tranexamic acid in spinal surgery has not yet been reached, and further research is needed to confirm it. This study is aimed at detecting the effectiveness and safety on the tranexamic acid in spinal surgery. Methods. The Cochrane Library, PubMed, Embase, CNKI, and other databases were searched. The search time was from 2016 to 2019. All randomized controlled trials comparing the topical tranexamic acid group and the control group were collected. The experimental group used topical application. Tranexamic acid was used to treat bleeding after spinal surgery. The control group was no tranexamic acid or isotonic saline. The total bleeding, blood transfusion rate, and the occurrence of deep vein thrombosis were compared between the two groups. Rev Man 5.2.0 software was used for meta-analysis. Results. A total of 8 randomized controlled trials were included, including 884 patients. Meta-analysis results showed that the total bleeding volume of the tranexamic acid group was lower than that of the control group, and the difference was statistically significant weighted mean difference ( WMD = – 360.27 mL , 95% confidence interval (CI) (–412.68, –307.87) mL, P < 0.00001 ). The blood transfusion rate in the tranexamic acid group was lower than that in the control group (odds ratio OR = 0.22 , 95% CI (0.14, 0.33), P < 0.00001 ). There was no significant difference in the incidence of deep vein thrombosis between the two groups: OR = 1.48 , 95% CI (0.41, 5.34), P = 0.55 . Conclusion. Tranexamic acid can significantly reduce perioperative total blood loss, intraoperative blood loss, and blood transfusion rate during spinal surgery but has no significant effect on blood transfusion and thrombosis.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

Bao

Lü

Gao

et al. 2022

Computational and Mathematical Methods in Medicine

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“…27 The third stage of labor is actively managed in all vaginal deliveries to reduce blood loss. 26,27,29,30 The main causes of PPH can be divided into the mnemonic of the four T's: tone (e.g., uterine atony, which is most common), trauma (e.g., cervical or vaginal lacerations), tissue (e.g., retained products, placenta accreta spectrum), and thrombin (e.g., inherited or acquired coagulation abnormalities). 27,28 Antepartum hemoglobin, shock index (heart rate divided by systolic blood pressure), lower immediate postpartum hemoglobin, fibrinogen, and lactate levels are associated with more severe PPH and transfusion requirements.…”

Section: Discussion: Pph General Considerationsmentioning

confidence: 99%

“…Older definitions of primary PPH used a different measure for vaginal delivery of 500 mL blood loss, which is still considered abnormal 27 . The third stage of labor is actively managed in all vaginal deliveries to reduce blood loss 26,27,29,30 . The main causes of PPH can be divided into the mnemonic of the four T’s: tone (e.g., uterine atony, which is most common), trauma (e.g., cervical or vaginal lacerations), tissue (e.g., retained products, placenta accreta spectrum), and thrombin (e.g., inherited or acquired coagulation abnormalities) 27,28 .…”

Section: Vwd Case and Discussion Of Obstetric Bleedingmentioning

confidence: 99%

“…Antifibrinolytics are effective treatment for PPH 30 . The ASH ISTH NHF WFH 2021 guideline panel 24 reviewed the literature and suggest the use of tranexamic acid for PPH prophylaxis in all patients with VWD.…”

Section: Vwd Case and Discussion Of Obstetric Bleedingmentioning

confidence: 99%

“…Antifibrinolytics are effective treatment for PPH. 30 The ASH ISTH NHF WFH 2021 guideline panel 24 reviewed the literature and suggest the use of tranexamic acid for PPH prophylaxis in all patients with VWD. Further details of this review can be found in Brignardello-Petersen et al 40 Tranexamic acid may be given orally or intravenously.…”

Section: Vwd Treatment For Delivery and The Postpartum Periodmentioning

confidence: 99%

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JTH in Clinic ‐ Obstetric bleeding: VWD and other inherited bleeding disorders

Johnsen

MacKinnon²

2022

Journal of Thrombosis and Haemostasis

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Individuals with inherited bleeding disorders (IBDs) have higher bleeding risk during pregnancy, childbirth, and the postpartum period. Clinical management requires recognition of the IBD as high risk for postpartum hemorrhage and a personalized multidisciplinary approach that includes the patient in decision making. When the fetus is known or at risk to inherit a bleeding disorder, fetal and neonatal bleeding risk also need to be considered. In pregnant IBD patients, it is common for providers to need to make decisions in the absence of high level of certainty evidence. We here present the case of a pregnant von Willebrand disease patient that reached multiple decision points where there is currently clinical ambiguity due to a lack of high level of certainty evidence. For each stage of her care, from diagnosis to the postpartum period, we discuss current literature and describe our approach. This is followed by a brief overview of considerations in other IBDs and pregnancy.

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