Prophylactic use of tranexamic acid reduces blood loss and transfusion requirements in patients undergoing cesarean section: A meta‐analysis

Abstract

Aim: Tranexamic acid (TXA) has been used to treat peripartum hemorrhage, while preoperative use of TXA in cesarean section (CS) remains controversial. To assess the effectiveness and safety of prophylactic application of TXA, a meta-analysis was performed. Methods: Electronic databases (MEDLINE [PubMed], Cochrane central register of controlled trials and Embase) were searched up to November 2018. The relevant data and quality of included trail were analyzed by RevMan 5.3. The study was registered at PROSPERO (CRD42018111165).Results: Twenty-one randomized controlled trials with a total of 3852 patients were included. Only one research reported thromboembolic events. Compared with control groups, the intra-operative blood loss (mean difference [MD] −155.23 mL, 95% confidence interval [CI] −195.64 − 114.81; P<0.01), postoperative blood loss (MD −26.67 mL, 95% CI −32.98 to −20.36; P<0.01), total blood loss (MD −184.88 mL, 95% CI −218.83 to −150.94; P<0.01), transfusion requirements (relative risk [RR] 0.29, 95% CI 0.18−0.49, P<0.01), massive hemorrhage (RR 0.39, 95% CI 0.30 to 0.51; P<0.01) and additional uterotonic agents use (RR 0.40, 95% CI 0.30−0.55, P<0.01) were markedly reduced in TXA-treated patients. Besides, TXA yielded a significant reduction in hemoglobin drop (MD −0.80 g/dL, 95% CI −1.07 to −0.53; P<0.01) and hematocrit drop (MD −2.05, 95% CI −3.09 to −1.01; P<0.01) compared with control groups. Conclusion: Prophylactic application of TXA can decrease perioperative blood loss and transfusion requirements in patients undergoing CS. More high-quality researches are needed to determine optimal dose of the drug.

Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis

“…After careful consideration from each authors, we decided to include three studies. [ 19 , 37 , 39 ] All of them were RCTs.…”

“…Despite clearly stating that the anesthesiologists were blinded, it was not clear who prepared the drugs. [ 39 ]…”

“…All three studies did blind the neurosurgeons and the anesthesiologists involved in the surgical procedure. [ 19 , 37 , 39 ] The person in charge of assessing intraoperative blood loss were blinded in Hooda et al . [ 19 ] Despite blinding the neurosurgeons and the anesthesiologist, Sutanto et al .…”

Blood loss and coagulation profile in pregnant and non-pregnant queens undergoing elective ovariohysterectomy

“…The antifibrinolytic agent tranexamic acid reduces death in women with postpartum hemorrhage, 28 and for women undergoing cesarian section, its prophylactic use decreases perioperative blood loss and transfusion requirements. 29 It should be emphasized that there is currently a lack of information available regarding the safety or efficacy of antifibrinolytics in feline patients. 30 Using individual measures of hemostatic status, such as platelet concentrations and aPTT, Rivera del Álamo et al 16 found no evidence of changes in coagulation parameters between pregnant cats and non-pregnant cats, or between non-pregnant cats at different stages of their reproductive cycles.…”

“…The antifibrinolytic agent tranexamic acid reduces death in women with postpartum hemorrhage, 28 and for women undergoing cesarian section, its prophylactic use decreases perioperative blood loss and transfusion requirements. 29 It should be emphasized that there is currently a lack of information available regarding the safety or efficacy of antifibrinolytics in feline patients. 30 …”