Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alam, Asim; Choi, Stephen

doi:10.1016/j.tmrv.2015.07.002

Cited by 56 publications

(61 citation statements)

References 34 publications

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“…Morbidity and mortality rates from PPH are devastating, affecting approximately 300 000 women and resulting in 72 000 deaths yearly in sub-Saharan Africa alone. 3 Maternal morbidity of a single individual in specific African nations was found to reduce the per capita GDP by US$0.36 per year. 15 Given the role of PPH in maternal morbidity, the economic burden on low-income and middle-income nations can be substantial.…”

Section: Open Accessmentioning

confidence: 99%

“…2 There is a demand for a safe, low-cost, effective therapy that can be administered in a wide range of healthcare settings to reduce the incidence of PPH. 3 The worldwide incidence of PPH is estimated to be between 6% and 11% with substantial regional variability. 4 5 The incidence of PPH is greatest in low/middle-income nations, particularly in sub-Saharan Africa where it can be larger than 30%.…”

Section: Introductionmentioning

confidence: 99%

“…9 Following these trends, the overall severe maternal morbidity rate between 2003 and 2011 has increased from 14.2 to 15.4 cases per 1000 deliveries in Canada. 12 Protocol for a pilot, randomised, doubleblinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1) Asim Alam, 1,2 Ameya Bopardikar, 1 Shelly Au, 1 Jon Barrett, 3 Jeannie Callum, 4 Alex Kiss, 5 Stephen Choi 1 …”

Section: Introductionmentioning

confidence: 99%

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Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1)

Alam

Bopardikar

et al. 2017

BMJ Open

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IntroductionPostpartum haemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Despite the availability of multiple uterotonic agents, the incidence of PPH continues to rise. Tranexamic acid (TXA) has been shown to be a safe, effective and inexpensive therapeutic option for the treatment of PPH, however, its use prophylactically in mitigating the risk of PPH is unknown. This pragmatic randomised prospective trial assesses the feasibility and safety of administering TXA at the time of delivery for the prevention of PPH.Methods and analysisA pilot pragmatic randomised double-blinded placebo-controlled trial will be performed. 58 singleton parturients at term >32 weeks, undergoing either spontaneous vaginal delivery, or caesarean section will be randomised to receive 1 g of TXA or placebo (0.9% saline) intravenously. The primary outcome assessed will be the feasibility of administrating TXA, along with collecting data regarding safety of drug administration. The groups will also be analysed on efficacy of mitigating the onset of PPH and clinically relevant variables. Demographic, feasibility, safety and clinical endpoints will be summarised and the appropriate measures of central tendency and dispersion will be presented.Ethics and disseminationThis protocol was approved by the Sunnybrook Health Sciences Centre Research Ethics Board (number: 418-2016). The results will be disseminated in a peer-reviewed journal and at scientific meetings.Trial registration number NCT03069859; Pre-results.

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Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1)

Alam

Bopardikar

et al. 2017

BMJ Open

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“…Although the prophylactic TXA administration may be associated with improved peripartum bleeding, existing evidence is insufficient for any definitive recommendations secondary to the poor to moderate quality of the literature [37].…”

Section: Tranexamic Acidmentioning

confidence: 99%

Massive Postpartum Hemorrhage: Protocol and Red Code

Masip¹,

Almeida-Toledano²,

Ferrero-Martínez³

et al. 2017

Obstetrics

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Postpartum hemorrhage (PPH) is the leading cause of maternal death. In developing countries, approximately 8% of maternal death is caused by PPH. Protocols should provide a standardized approach to evaluate and monitor the patients. A standard protocol must be recognized by the institution and must be accepted and known by all team members. Additionally, it is important to have a massive obstetric hemorrhage protocol (red code) for those patients with an important bleeding who require blood products available as soon as possible. In the red code activation protocol there are several key points to consider: the management algorithm must be known and accepted by all team members, a clear and effective communication between the team must be established and all the participants must know the role they play. Massive obstetric hemorrhage has a multidisciplinary implication: obstetricians, anesthesiologists, pediatricians, midwife, nurses, auxiliary staff, and laboratory blood bank staff. The active participation of the multidisciplinary team in simulations before the protocols implementation facilitates the evaluation of critical points and subsequent changes before their final application, the assessment of the adequacy of circuits and infrastructure, as well as a better protocols compliance.

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“…Since meta-analyses are only as good as the source data on which they are based, the interpretation of these results should remain cautious 2 4. The authors assert that the studies included were heterogeneous with respect to sample sizes (which range from 74 to 740) and were downgraded to only moderate quality 3.…”

Section: Commentarymentioning

confidence: 99%

Prophylactic tranexamic acid in addition to uterotonics may prevent blood loss for vaginal and caesarean deliveries

Sentilhes¹,

Deneux‐Tharaux

2016

Evid Based Med

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Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 56 publications

References 34 publications

Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1)

Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1)

Massive Postpartum Hemorrhage: Protocol and Red Code

Prophylactic tranexamic acid in addition to uterotonics may prevent blood loss for vaginal and caesarean deliveries

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