The Effect of Tranexamic Acid on Preventing Post-partum Hemorrhage Due to Uterine Atony: A Triple-blind Randomized Clinical Trial

Zargar, Mahvash; Nikbakht, Roshan; Ahmadi, Mahzad

doi:10.2174/1574884713666180507101002

Cited by 7 publications

(8 citation statements)

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“…31 12 patients (8%) in the study group compared to 26 patients (17%) in the control group needed blood transfusion which has also been observed in erstwhile trails. 32,33 6 patients in the study group had to stay for more than 3 days compared 14 patients in control group.…”

Section: Discussionmentioning

confidence: 94%

Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

Ginjupalli¹,

Anuradha²,

Suyajna³

2021

Int J Reprod Contracept Obstet Gynecol

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Background: The use of anti-fibrinolytic therapy has potential to reduce obstetric blood loss due to profound changes that take place in the fibrinolytic system during normal childbirth. Objective was to evaluate the efficacy of tranexamic acid in reducing postpartum hemorrhage (PPH) during normal labour.Methods: Patients who planned for normal delivery and fulfilling the inclusion criteria were recruited for the study. The pre-delivery parameters -pulse rate, blood pressure, Hb gm% and PCV% were measured for each patient. The study group received injection oxytocin (10 IU) and injection tranexamic acid (500 mg) slow intravenous route. The control group received injection oxytocin (10 IU) and placebo injection. Immediately after delivery of the anterior shoulder of the baby, when all the liquor was drained, Brasse-V drape is placed under the patient. Then the patient was given pre-weighed pads, which were weighed 2 hours post-partum. Final blood loss was calculated by combining amount of blood collected in the drape and blood absorbed by the pads.Results: The total number of patients studied was 300- equally distributed in both the groups. There was a significant increase in the pulse rate and decrease in blood pressure in the control group compared to the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group. The blood loss was significantly low in the study group. The need for other uterotonics, blood transfusion, and duration of hospital stay, were significantly low in study group.Conclusions: Tranexamic acid, when given prophylactically to the women with vaginal delivery who received prophylactic oxytocin, appears to reduce the blood loss effectively compared to placebo alone.

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Section: Discussionmentioning

confidence: 94%

Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

Ginjupalli¹,

Anuradha²,

Suyajna³

2021

Int J Reprod Contracept Obstet Gynecol

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“…Out of the 20 studies examining TXA effectiveness, 14 (70%) were randomized controlled trials (RCTs) [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] and the rest non-randomized trials [ 32 , 33 , 34 , 35 , 36 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the trials tested TXA not only for PPH treatment but also for PPH prevention. While TXA was most of the time compared with routine care and placebo, a few studies used other comparators or combined TXA with other medications, including misoprostol sublingual [ 20 , 21 ], misoprostol per rectum [ 29 ], a prostaglandin analog [ 31 , 34 ], and fibrinogen [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

Tranexamic Acid for Postpartum Hemorrhage Treatment in Low-Resource Settings: A Rapid Scoping Review

Tran

Bar-Zeev

Schulte-Hillen³

et al. 2022

IJERPH

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Tranexamic acid (TXA) effectively reduces bleeding in women with postpartum hemorrhage (PPH) in hospital settings. To guide policies and practices, this rapid scoping review undertaken by two reviewers aimed to examine how TXA is utilized in lower-level maternity care settings in low-resource settings. Articles were searched in EMBASE, MEDLINE, Emcare, the Maternity and Infant Care Database, the Joanna Briggs Institute Evidence-Based Practice Database, and the Cochrane Library from January 2011 to September 2021. We included non-randomized and randomized research looking at the feasibility, acceptability, and health system implications in low- and lower-middle-income countries. Relevant information was retrieved using pre-tested forms. Findings were descriptively synthesized. Out of 129 identified citations, 23 records were eligible for inclusion, including 20 TXA effectiveness studies, two economic evaluations, and one mortality modeling. Except for the latter, all the studies were conducted in lower-middle-income countries and most occurred in tertiary referral hospitals. When compared to placebo or other medications, TXA was found effective in both treating and preventing PPH during vaginal and cesarean delivery. If made available in home and clinic settings, it can reduce PPH-related mortality. TXA could be cost-effective when used with non-surgical interventions to treat refractory PPH. Capacity building of service providers appears to need time-intensive training and supportive monitoring. No studies were exploring TXA acceptability from the standpoint of providers, as well as the implications for health governance and information systems. There is a scarcity of information on how to prepare the health system and services to incorporate TXA in lower-level maternity care facilities in low-resource settings. Implementation research is critically needed to assist practitioners and decision-makers in establishing a TXA-inclusive PPH treatment package to reduce PPH-related death and disability.

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“…Other treatments for postpartum hemorrhage were compared to TXA. It was shown that both intramuscular prostaglandin analogues (0.25 mg every 15-90 min to a maximum of 8 doses) and rectally administered misoprostol (5 doses of 200 µg) were as effective in reducing bleeding as intravenous TXA, and sublingually administered misoprostol (600 µg) was significantly less effective [65][66][67].…”

Section: Obstetrics and Gynecologic Surgerymentioning

confidence: 99%

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

et al. 2021

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Objectives We review the evidence for tranexamic acid (TXA) for the treatment and prevention of bleeding caused by surgery, trauma and bleeding disorders. We highlight therapeutic areas where evidence is lacking and discuss safety issues, particularly the concern regarding thrombotic complications. Methods An electronic search was performed in PubMed and the Cochrane Library to identify clinical trials, safety reports and review articles. Findings TXA reduces bleeding in patients with menorrhagia, and in patients undergoing caesarian section, myomectomy, hysterectomy, orthopedic surgery, cardiac surgery, orthognathic surgery, rhinoplasty, and prostate surgery. For dental extractions in patients with bleeding disorders or taking antithrombotic drugs, as well as in cases of idiopathic epistaxis, tonsillectomy, liver transplantation and resection, nephrolithotomy, skin cancer surgery, burn wounds and skin grafting, there is moderate evidence that TXA is effective for reducing bleeding. TXA was not effective in reducing bleeding in traumatic brain injury and upper and lower gastrointestinal bleeding. TXA reduces mortality in patients suffering from trauma and postpartum hemorrhage. For many of these indications, there is no consensus about the optimal TXA dose. With certain dosages and with certain indications TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery, and an increased mortality after delayed administration of TXA for trauma events or postpartum hemorrhage. Whereas most trials did not signal an increased risk for thrombotic events, some trials reported an increased rate of thrombotic complications with the use of TXA for gastro-intestinal bleeding and trauma. Conclusions TXA has well-documented beneficial effects in many clinical indications. Identifying these indications and the optimal dose and timing to minimize risk of seizures or thromboembolic events is work in progress.

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The Effect of Tranexamic Acid on Preventing Post-partum Hemorrhage Due to Uterine Atony: A Triple-blind Randomized Clinical Trial

Cited by 7 publications

References 0 publications

Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

Tranexamic Acid for Postpartum Hemorrhage Treatment in Low-Resource Settings: A Rapid Scoping Review

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

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