Tranexamic acid for preventing postpartum haemorrhage after caesarean section

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Evidence-Based Medicine

Background:

• Postpartum hemorrhage (PPH) is a significant risk during cesarean births.
• Tranexamic acid (TXA) is an antifibrinolytic drug used to treat PPH.
• The prophylactic use of TXA for preventing PPH requires robust evidence on efficacy and safety.

Approach:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Included six RCTs with 15,981 participants, focusing on TXA for PPH prevention during cesarean birth.
• Assessed risk of bias and certainty of evidence using GRADE methodology.

Key Points:

• Prophylactic TXA showed little to no difference in estimated blood loss (≥1000 mL) but likely a slight reduction in calculated blood loss (≥1000 mL).
• Evidence for severe maternal morbidity, maternal death, thromboembolic events, and hysterectomy remains very uncertain due to low event rates.
• Little to no difference was observed in blood transfusions, additional surgical interventions, or need for additional uterotonics.

Conclusions:

• Prophylactic TXA during cesarean birth has minimal impact on estimated blood loss and a potential slight benefit for calculated blood loss.
• Uncertainty surrounding serious adverse events and low PPH morbidity rates necessitate careful consideration before routine implementation.
• The cost-effectiveness and applicability to high-risk populations require further investigation.