Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Abstract

We sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; N = 330) or 30 mL 5% glucose prior to surgery. The primary outcome was the estimated blood loss following CS. No demographic difference was observed between groups. The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (499.9 ± 206.4 mL versus 600.7 ± 215.7 mL, respectively; P < 0.001), and the proportion of women in the TA group who had an estimated blood loss >1000 mL was significantly lower than in the placebo group (7 [2.1%] versus 19 [5.8%], respectively; relative risk [RR] 2.7; 95% confidence interval [CI] 1.1 to 6.3; P < 0.03). Furthermore, more women in the placebo group than in the TA group required additional uterotonic agents (48 [14.5%] versus 28 [8.5%], respectively; RR 1.7; 95% CI 1.1 to 2.6; P = 0.02). Maternal and neonatal outcomes did not differ significantly. TA significantly reduced bleeding during CS, the percentage of patients with blood loss >1000 mL, and the need for additional uterotonic agents. Furthermore, the incidence of thromboembolic events did not increase. Our results suggest that TA can be used safely and effectively to reduce CS bleeding.

Role of Intravenous Tranexamic Acid on Caesarean Blood Loss: A Prospective Randomised Study

“…None of the babies required NICU admission. Results were comparable to previous studies [6,7,9,11,12].…”

Efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section

“…10 In the study conducted by Gungorduck et al a prospective, randomized, double-blind, placebo-controlled study showed the mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group. 13 The mean blood loss in the present study was similar to the study Gungorduck et al but more than the studies Gai 10,11,13,14 But in all the studies as ours the use of tranexamic acid in the study group statistically decreased the amount of blood loss during caesarean section.…”

“…10 In the studies conducted by Shekavat et al, Gungorduck et al the result was similar to the present study where tranexamic acid group had greater mean hemoglobin and haematocrit 24 hrs after surgery. 11,13 In the present study need for additional uterotonic requirement of 21-40 U and >40 U Syntocin was seen in placebo group compared to tranexamic acid group. The result showed that the usage of injection tranexamic acid among study group had significantly decreased need for additional uterotonics.…”

“…But in study by Gungorduck et al times gap of 10 min was taken for administration of drug, whereas in study by Gohel et al and Movafegh et al the time gap of 20 min was taken for administration of drug. 10,13,14 The outcome clearly showed that the blood loss was decreased by the usage of prophylactic 1g IV tranexamic acid before caesarean section. The blood loss decreased during postoperative period for 6 hrs with injection tranexamic acid was only 5.7 ml with 95% CI of-9.18ml -2.212ml.…”

Role of Incisional infiltration with intraperitoneal instillation analgesia in non descent vaginal hysterectomy

“…Gungorduk et al [30] found TXA significantly reduced bleeding during CS, the percentage of patients with blood loss >1000 ml, and the need for additional uterotonic agents.…”