Role of Intravenous Tranexamic Acid on Caesarean Blood Loss: A Prospective Randomised Study

Abstract

Background Post-partum haemorrhage (PPH) is a major cause of maternal mortality globally. Tranexamic acid, an anti-fibrinolytic agent, is a novel approach in an attempt to prevent this dreadful complication. This study aims to document the efficacy of intravenous (IV) tranexamic acid in reducing blood loss during and after caesarean section (CS). Methods In this prospective randomised placebo-controlled open-label study, 100 mothers scheduled for elective CS were randomly selected and divided into two groups (study and control) of 50 each. The study group received 1 g IV tranexamic acid and the control group received IV placebo. Following delivery, all mothers received ten units of oxytocin in 500 ml of normal saline.Results The mean intra-operative and post-partum blood loss were significantly lower in the study group than the control group: 499.11 ± 111.2 and 59.93 ± 12.5 ml versus 690.85 ± 198.41 and 110.06 ± 13.47 ml, respectively, (p \ 0.001). Total blood loss was 30 % less in the study group (p \ 0.001). Six mothers had PPH in the control group, while none in the study group. The difference between the pre-operative and post-operative haemoglobin levels was significantly less in the study group than the control group, 0.26 ± 0.22 versus 0.99 ± 0.48 g% (p \ 0.001).There was no significant difference with respect to other haematological parameters. There was no added adverse effect or need for NICU admission in the study group. Conclusion Pre-operative IV tranexamic acid significantly reduced blood loss during elective CS without any significant adverse effects.

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…A recent meta‐analysis of nine trials involving 2365 patients confirmed these findings, demonstrating that the administration of tranexamic acid before cesarean delivery significantly reduces intra‐ and postoperative blood loss and blood transfusion with no increase in thromboembolic events . After this analysis, three more placebo‐controlled trials have shown that tranexamic acid administration immediately before cesarean delivery significantly reduces reported intraoperative blood loss and postoperative declines in hemoglobin without any increase in adverse maternal or neonatal effects …”

“…48 After this analysis, three more placebocontrolled trials have shown that tranexamic acid administration immediately before cesarean delivery significantly reduces reported intraoperative blood loss and postoperative declines in hemoglobin without any increase in adverse maternal or neonatal effects. [49][50][51] No trials have specifically examined the role of tranexamic acid in the surgical management of PAS disorders. However, the quality of the evidence on postpartum hemorrhage justifies its use in the management of women diagnosed prenatally or presenting with PAS disorders at the time of delivery.…”

Prophylactic use of tranexamic acid reduces blood loss and transfusion requirements in patients undergoing cesarean section: A meta‐analysis

“…Seven trial registrations without sufficient data for analysis were also excluded. Finally, 21 studies (19 research papers and 2 conference abstracts) with 3852 patients were eligible for our analysis. Figure shows the details of study selection and inclusion.…”

“…However, there is still a controversy about the prophylactic application of TXA to patients undergoing CS. Thus, we identified all available randomized controlled trials (RCT), totally 21, to evaluate whether preoperative administration of TXA has potential effects on reducing blood loss as well as transfusion requirements for patients undergoing CS. Moreover, we also investigated the impact of TXA on other factors associated with bleeding, including hemoglobin and hematocrit drops, additional uterotonic agent use (oxytocin and methylergometrine) and massive hemorrhage rate.…”

Role of intravenous tranexamic acid in reducing blood loss during caesarean section: Study at tribal‐dominated area hospital in Chhattisgarh, India

“…6 TXA has also been studied extensively to reduce blood loss in and after CS. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Intravenous TXA is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine binding site on plasminogen molecules. Adverse drug reaction of TXA are nausea, headache, and thromosis.…”