Preoperative Tranexamic Acid in conjunction with Crystalloid Co-load improves the outcome of Elective Cesarean Section under spinal anesthesia

Abstract

Objective: To evaluate therapeutic yield of tranexamic acid (TXA) injection and fluid co-load on the outcome of cesarean section (CS) conducted under spinal anesthesia Study Design : Prospective randomized comparative study. Patients and Methods: The current included 174 primipara scheduled for elective CS under spinal anesthesia. Intravenous (IV) fluid co-load (15 ml/kg warm lactated ringer solution) started as fast drip during and continued after spinal anesthesia. Patients were randomly allocated into two equal groups: Group TXA received a loading IV dose of 500 mg TXA 20 minutes before surgery followed by continuous TXA infusion at rate of 1 mg/kg/min till end of surgery. Group C did not receive prophylactic TXA, but both groups received a booster dose of 2 gm TXA if required. Patients were monitored for the frequency and severity of hypotension and dose of ephedrine used. Amount of bleeding since skin incision till 2-hours postpartum (PP), the frequency of patients had stopped PP bleeding till 2-hr PP and the total dose of oxytocin drugs and booster doses of TXA were recorded. Results: Hypotension was recorded in 53 patients (30.5%); only 12 patients had blood pressure <80 mmHg. The lowest blood pressure, frequency of hypotension, time of occurrence and duration of hypotension and the used dose of ephedrine showed non-significant difference between both studied groups. The amount of perioperative bleeding was significantly lower in TXA group compared to control group. Twenty parturient had continued PP bleeding for more than 2 hours PP with significantly (p=0.038) lower frequency of bleeders in TXA group. All women had continued bleeding received booster doses of TXA with a significantly higher dose in control group compared to TXA group. Conclusion: Preoperative administration of TXA significantly reduced perioperative bleeding with significant reduction of consumption of TXA booster doses and utrotonics without affecting safety. Fluid coloading allowed reduction of the frequency and extent of hypotension concomitant with spinal anesthesia.