Tranexamic acid limits postpartum hemorrhage

Prophylactic tranexamic acid administration — on top of routine uterotonics — is effective in lowering postpartum blood loss and limiting hemoglobin drop in women undergoing cesarean delivery, according to a meta-analysis.

“This meta-analysis provides reinforcing evidence about the efficacy and safety of prophylactic tranexamic acid in women undergoing cesarean delivery. The benefit is greater in low-middle income countries, where postpartum hemorrhage is more common and difficult to treat,” Ioannis Bellos, MD, of the laboratory of experimental surgery and surgical research at Athens University Medical School in Greece, told Healio. “Tranexamic acid may be used not only for the treatment but also for the prevention of postpartum hemorrhage in the setting of cesarean delivery.”

Bellos and colleagues examined 36 randomized clinical trials that compared IV TXA administration to placebo in women undergoing cesarean delivery. The analysis included a total of 10,659 women.

TXA was administered at a fixed dose of 1 g across most of the studies and was given alongside conventional uterotonic agents such as oxytocin, which was used in most of the trials, the researchers said.

Compared with placebo, TXA was associated with lower blood loss (mean difference, –189.44 mL; 95% CI, –218.63 to –160.25). The study also found lower rates of hemoglobin drop (mean difference, 8.22%; 95% CI, 5.54-10.9), and a drop in postpartum hemorrhage rates (blood loss > 1000 mL; OR = 0.37; 95% CI, 0.22-0.6).

The study showed that among women who were treated with TXA, the need for red blood cell transfusion was significantly lower (OR = 0.41; 95% CI, 0.26-0.65) compared with women who received placebo.

The authors noted that further research is needed to determine TXA’s effects on special high-risk populations, the optimal dosing strategy and the risk for thromboembolic events.