Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice With Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study

Güngördük, Kemal; Ascoğlu, Osman; Yldrm, Gokhan; Ark, Cemal; Tekirdağ, Ali İsmet; Besmoglu, Berhan

doi:10.1097/01.ogx.0000436756.05118.cd

Cited by 28 publications

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“…Our results agreed with the results of Gungorduk, et al and Mirghafourvand, et al [14,21] in which they reported that the use of uterotonics was less frequently in the women receiving TA versus placebo although they reported a statistical signifi cant difference between both groups in both studies. Use of TA for preventing PPH can help in reduction in blood transfusion, which is expensive and may be not available in many settings.…”

Section: Discussionsupporting

confidence: 82%

“…There was signifi cant reduction in blood loss volume in women who received TA versus placebo (337.4±100.6 versus 436.9±106.3 mL, respectively; p<0.001). These results were keeping in track with the study of Gungorduk et al in which blood loss volume in women who received TA versus placebo (261.5±146.8 versus 349.9±188.85 mL, respectively; p<0.001) [14]. Also our results keep with Mirghafourvand et al, who reported blood loss greater than 500 mL was less common in women who received TA [21].…”

Section: Discussionsupporting

confidence: 81%

“…Three previous randomized controlled studies have shown that TA reduces PPH after vaginal delivery [14,20,21]. The same effect observed in our study.…”

Section: Discussionsupporting

confidence: 80%

“…In all previous studies, mean blood loss volume was measured by weighing a sheet soaked from the end of the delivery till 2 hours after birth [14,20,21]. We think that using the drape is more accurate in estimating the amount of blood loss after delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Previous study estimated blood loss with use of placebo in third stage of labor was 350 ml and after use of TA was 260 ml with mean difference about 90 ml [14]. Using a two-sided chi-square ( 2) test with an  of 0.05, a total sample size was calculated to be at least 190 patients in the 2 groups (95 in each arm) with 95% power to detect a 25% difference in the both groups.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of Subendometrial and Intramyometrial Blood Flow after Intravenous Tranexamic Acid for Prevention of Postpartum Hemorrhage in Vaginal Delivery: A Randomized Controlled Study

Ismail¹,

Abbas²,

Shahat³

et al. 2017

J Gynecol Res Obstet

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Objective: The study aims to test the effect of tranexamic acid (TA) on uterine vasculature and blood loss after vaginal delivery. Materials and methods:A randomized, double-blind, placebo-controlled trial, conducted in Assiut Woman's Health Hospital, Egypt between the 1st of October 2015 and the 31st of March 2016 included pregnant women (37-42 weeks) with a single living cephalic fetus. The eligible women were randomized to receive TA or placebo after vaginal delivery. Doppler indices were measured for the subendometrial, intramyometrial and uterine blood vessels two hours after delivery. The main study outcome was the effect of TA on subendometrial and intramyometrial blood fl ow. Results:Two hundred women were enrolled (n=100 in each group). There was a signifi cant increase in the Doppler indices of subendometrial and intramyometrial blood vessels with no difference in indices in uterine arteries between both groups. The mean of estimated blood loss decreased signifi cantly in TA group (p<0.001). The haematocrit and hemoglobin levels were higher in TA group than the placebo group after delivery (p<0.001). Conclusions:The use of intravenous TA after vaginal delivery increases the resistance in the subendometrial and intramyometrial blood vessels and reduces postpartum hemorrhage.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 81%

“…Three previous randomized controlled studies have shown that TA reduces PPH after vaginal delivery [14,20,21]. The same effect observed in our study.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Evaluation of Subendometrial and Intramyometrial Blood Flow after Intravenous Tranexamic Acid for Prevention of Postpartum Hemorrhage in Vaginal Delivery: A Randomized Controlled Study

Ismail¹,

Abbas²,

Shahat³

et al. 2017

J Gynecol Res Obstet

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Antifibrinolytics: Indications and Precautions

Harthy

Kouides

2016

Nonmalignant Hematology

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Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice With Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study

Cited by 28 publications

References 0 publications

Evaluation of Subendometrial and Intramyometrial Blood Flow after Intravenous Tranexamic Acid for Prevention of Postpartum Hemorrhage in Vaginal Delivery: A Randomized Controlled Study

Evaluation of Subendometrial and Intramyometrial Blood Flow after Intravenous Tranexamic Acid for Prevention of Postpartum Hemorrhage in Vaginal Delivery: A Randomized Controlled Study

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Antifibrinolytics: Indications and Precautions

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