Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta‐analysis of randomized controlled trials

Simonazzi, Giuliana; Bisulli, M.; Saccone, Gabriele; Moro, Elisa; Marshall, Ariela L.; Berghella, Vincenzo

doi:10.1111/aogs.12798

Cited by 120 publications

(99 citation statements)

References 29 publications

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“…Nonetheless, more than 70% of procedures were elective C/S and thus there is an opportunity to further decrease exposure at delivery for planned procedures by considering routine use of antifibrinolytics or RBC salvage. Several randomized controlled trials have included patients receiving tranexamic acid prophylactically for C/S and have suggested that tranexamic acid is useful to reduce blood loss and RBCT . RBC salvage is also an option as its use in obstetrics has not been associated with increased risk of alloimmunization or amniotic fluid embolism …”

Section: Discussionmentioning

confidence: 99%

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

et al. 2017

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“…This is not a uterotonic agent; TXA is an anti-fibrinolytic agent better known to gynaecologists for oral use as treatment of menorrhagia, and to trauma surgeons where it has been shown to reduce blood loss. 7 Topical application of tranexamic acid provides a high drug concentration at the site of the wound and a low systemic concentration. Studies from cardiac and orthopedic surgery have shown an equal or superior effect of topical compared with intravenous tranexamic acid on both bleeding and transfusion requirement.…”

mentioning

confidence: 99%

“…8 There are several published clinical trials for the use of TXA in the obstetric setting as well, but no consensus on its use or guidelines for management. 7 In the view of limited, good-quality evidence is available to inform on the best practices for prevention of bleeding at caesarean section due to placenta previa. Present study aimed at evaluating role of adjunctive IV Tranexamic acid versus topical Tranexamic acid infusion of the placental bed for prevention of postpartum haemorrhage in women with placenta previa.…”

mentioning

confidence: 99%

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Shady

Sallam

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Placenta previa one of the famous etiology of excessive blood loss during and after cesarean section. The objective of this study was to determine the effect of prophylactic adjunctive IV versus topical tranexamic acid (TA) on calculated and measured blood loss during and after caesarean section due to placenta previa compared with standard IV oxytocin alone.Methods: In this double-blind randomized controlled trial, 120 women were undergoing caesarean delivery for placenta previa (PP) were randomly allocated to receive 10 IU oxytocin IV after placental delivery, or receive 1 gm tranexamic acid IV just before skin incision plus 10 IU oxytocin IV after placental delivery or received 10 IU oxytocin IV after placental delivery plus 2 gm topical tranexamic acid applied on placental bed. The main outcome was to measure blood loss during and 4-hour post caesarean delivery.Results: 120 women were enrolled (n = 40 in each group). Both groups of women received IV tranexamic acid (Group II) and topical tranexamic acid (Group III) showed great reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received 10 IU oxytocin only (P = 0.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in group II and III showed highly reduction compared with group I (P = 0.0001, 0.0001).Conclusions: Prophylactic adjunctive TA topical application on the placental bed or iv administration reduces blood loss during and after caesarean delivery in women with a placenta previa. novel application of topical tranexamic acid on the placental bed is effective in reduce intraoperative and postoperative bleeding in comparison with IV route with elimination of theoretical risk of thrombi embolism complication with IV rout.

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“…A systematic review (Simonazzi et al, 2016) confirmed that TXA can significantly decrease the incidence of PPH with an amount of blood loss >500 ml and severe PPH with blood loss > 1000ml. Consume of coagulation factors and platelets were reported in cases with severe postpartum bleeding.…”

Section: Exploratory Subgroup Analysesmentioning

confidence: 99%

Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation

Dallaku¹,

Shakur²,

Edwards³

et al. 2017

Wellcome Open Res

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Abstract. Postpartum haemorrhage (PPH) is a potentially life-threatening Background complication for women, and the leading cause of maternal mortality. Tranexamic acid (TXA) is an antifibrinolytic used worldwide to treat uterine haemorrhage and to reduce blood loss in general surgery. TXA may have effects on thrombin generation, platelet function and coagulation factors as a result of its inhibition on the plasmin.. WOMAN ETAPlaT is a sub-study of the World Maternal Methods Antifibrinolitic trial (WOMAN trial). All adult women clinically diagnosed with PPH after a vaginal delivery or caesarean section, are eligible for inclusion in the study. Blood samples will be collected at the baseline and 30 minutes after the first dose of study treatment is given. Platelet function will be evaluated in whole blood immediately after sampling with Multiplate® tests (ADPtest and TRAPtest). Thrombin generation, fibrinogen, D-dimer, and coagulation factors vW, V and VIII will be analysed using platelet poor plasma.Recruitment to WOMAN ETAPlaT started on 04 November 2013 and Results. closed on 13 January 2015, during this time 188 patients were recruited. The final participant follow-up was completed on 04 March 2015. This article introduces the statistical analysis plan for the study, without reference to unblinded data.The data from this study will provide evidence for the effect of Conclusion. TXA on thrombin generation, platelet function and coagulation factors in women with PPH. Amendments from Version 1The differences of the second version of "Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation" has been based on the comments from referees:1. Removed the exploratory subgroup analysis section, because the total sample size was small and the subgroup analyses run the risk of false positive. Also, it was removed a section with evidence about effect of TXA on thrombin generation, because some evidence it was provided at the protocol paper of ETAPlaT sub-study.2. We added a flowchart according to CONSORT to report the participant progress in the ETAPlaT sub-study (Figure 1), allocation of patients in TXA or placebo group, lost of follow up and exclusion from analysis. Two sections were added, one section for safety report for all patients randomized in the substudy, about adverse events and serious adverse events. Another section added was about adherence, to report measures of compliance by trial arm. See referee reports REVISED PrefaceThe purpose of the statistical analysis plan (SAP) is to ensure the credibility of the study findings by pre-specifying the statistical approaches to the analysis of the study data prior to hard locking the database and unblinding of the WOMAN ETAPlaT trial data. To prevent outcome bias and selective reporting, a detailed SAP is presented in order to avoid post hoc decisions that may influence the interpretation of the results and the statistical analyses of the final data.This SAP is a technical extension of the WOMAN ...

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Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta‐analysis of randomized controlled trials

Cited by 120 publications

References 29 publications

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial

Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation

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