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Published on: September 10, 2018
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Prophylactic tranexamic acid in Cesarean delivery: an updated meta-analysis with a trial sequential analysis
Henrique Provinciatto1, Maria E Barbalho2, Pedro M da Câmara3
1Barao de Maua University Center, Avenida Portugal, 2433, Ribeirao Preto, SP, Brazil. henriquegprovinciatto@gmail.com.
Summary
Tranexamic acid (TXA) effectively prevents postpartum hemorrhage (PPH) in Cesarean delivery patients. This safe strategy reduces blood loss and the need for transfusions or additional uterotonics without increasing adverse events.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Evidence-Based Medicine
Background:
- Postpartum hemorrhage (PPH) is a major global cause of maternal mortality.
- Conflicting evidence exists regarding the prophylactic use of tranexamic acid (TXA) during Cesarean delivery.
Approach:
- A systematic review and meta-analysis of 38 randomized controlled trials (RCTs) involving 22,940 patients undergoing Cesarean delivery.
- Trial sequential analysis (TSA) was employed to assess the reliability of the findings.
Key Points:
- Prophylactic TXA significantly reduced PPH incidence (RR, 0.51; 95% CI, 0.38-0.69).
- TXA also decreased the need for blood transfusions (RR, 0.43; 95% CI, 0.30-0.61) and additional uterotonics (RR, 0.52; 95% CI, 0.40-0.68).
- No significant increase in adverse events or thromboembolic events was observed.
Conclusions:
- Prophylactic administration of TXA is a safe and effective strategy for reducing blood loss and PPH in patients undergoing Cesarean delivery.
- The findings support the routine use of TXA for PPH prophylaxis in this population.
