Giuliana Simonazzi1, Maria Bisulli1, Gabriele Saccone2, Elisa Moro1, Ariela Marshall3,4, Vincenzo Berghella5. 1. Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy. 3. Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 4. Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA. 5. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Abstract
INTRODUCTION: There are several published clinical trials of the use of tranexamic acid (TXA) in an obstetric setting, but no consensus on its use or guidelines for management. MATERIAL AND METHODS: The aim of this meta-analysis was to evaluate the effectiveness of TXA in reducing blood loss when given prior to cesarean delivery. We performed a systematic search in electronic databases. We included all randomized controlled trials comparing the use of TXA prior to cesarean delivery with controls (either placebo or no treatment). RESULTS: Nine trials with 2365 women were included in the analysis. Women who received TXA had significantly less postpartum blood loss, a lower drop in hemoglobin and a lower incidence of postpartum hemorrhage and severe postpartum hemorrhage compared with controls. Moreover, the number of women who needed additional uterotonic agents was significantly lower in the TXA group than in controls. The percentage of women who required blood transfusions at, or immediately after, cesareans was significantly lower in the intervention group than in the controls. There was no difference in the incidence of thromboembolic events in the two groups. CONCLUSIONS: Prophylactic TXA given before cesarean skin incision in women undergoing cesarean delivery, under spinal or epidural anesthesia, significantly decreases blood loss, including postpartum hemorrhage and severe postpartum hemorrhage, in addition to the standard prophylactic oxytocin given after delivery of the neonate. The effect of TXA on thromboembolic events and mortality as well as its use in high-risk women should be investigated further.
INTRODUCTION: There are several published clinical trials of the use of tranexamic acid (TXA) in an obstetric setting, but no consensus on its use or guidelines for management. MATERIAL AND METHODS: The aim of this meta-analysis was to evaluate the effectiveness of TXA in reducing blood loss when given prior to cesarean delivery. We performed a systematic search in electronic databases. We included all randomized controlled trials comparing the use of TXA prior to cesarean delivery with controls (either placebo or no treatment). RESULTS: Nine trials with 2365 women were included in the analysis. Women who received TXA had significantly less postpartum blood loss, a lower drop in hemoglobin and a lower incidence of postpartum hemorrhage and severe postpartum hemorrhage compared with controls. Moreover, the number of women who needed additional uterotonic agents was significantly lower in the TXA group than in controls. The percentage of women who required blood transfusions at, or immediately after, cesareans was significantly lower in the intervention group than in the controls. There was no difference in the incidence of thromboembolic events in the two groups. CONCLUSIONS: Prophylactic TXA given before cesarean skin incision in women undergoing cesarean delivery, under spinal or epidural anesthesia, significantly decreases blood loss, including postpartum hemorrhage and severe postpartum hemorrhage, in addition to the standard prophylactic oxytocin given after delivery of the neonate. The effect of TXA on thromboembolic events and mortality as well as its use in high-risk women should be investigated further.
Authors: Philipp Helmer; Tobias Schlesinger; Sebastian Hottenrott; Michael Papsdorf; Achim Wöckel; Magdalena Sitter; Tobias Skazel; Thomas Wurmb; Ismail Türkmeneli; Christoph Härtel; Stefan Hofer; Ibrahim Alkatout; Leila Messroghli; Thierry Girard; Patrick Meybohm; Peter Kranke Journal: Anaesthesist Date: 2022-03-04 Impact factor: 1.041
Authors: Kastriot Dallaku; Haleema Shakur; Phil Edwards; Danielle Beaumont; Ian Roberts; Sumaya Huque; Maria Delius; Ulrich Mansmann Journal: Wellcome Open Res Date: 2016-12-15