Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial

Yehia, Ahmed; Koleib, Magdy H.; Abdelazim, Ibrahim A.; Atik, Ahmed

doi:10.1016/s2305-0500(14)60002-6

Cited by 46 publications

(41 citation statements)

References 10 publications

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“…However, they were well designed and well implemented. Eighteen trials [10–12,14,15,17–19,21–24,28–31,33,34] provided detailed randomization techniques using a computer-generated randomization list, consecutively numbered sealed opaque envelopes or rand list software, while 7 trials [16,20,25–27,31,32] referred to randomization only without describing the detailed method. Eleven trials [10,11,13,16,21,23,25,31,32] had unclear bias in the allocation concealment while only 1 study [12] presented a higher bias.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 614 trials [10,11,13,15,17–19,22–25,27,28,31] and 2 trials [32,34] provided detailed data on the effect of TA on the intraoperative blood loss (from fetus delivery to placental delivery) in CS and VD, respectively. Our results indicated that TA administration in CS resulted in a reduced blood loss by a mean volume of 141.25 mL (95% CI −186.72 to −95.79; I 2 = 99%) and a reduced blood loss by a mean volume of 22.88 mL (95% CI −50.54 to 4.77; I 2 = 0%) in VD as compared to control group.…”

Section: Resultsmentioning

confidence: 99%

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Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?

Gong

Dong

et al. 2017

Medicine

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Background:To assess the efficacy and safety of tranexamic acid (TA) in reducing blood loss and lowering transfusion needs for patients undergoing caesarean section (CS) or vaginal delivery (VD).Methods:An electronic literature search of PubMed, EMBASE, OVID, Cochrane library, Scopus, Central, and Clinical trials.gov was performed to identify studies that evaluating the usage of TA in CS or VD. The methodological quality of included trials was assessed and data extraction was performed.Results:Finally, 25 articles with 4747 participants were included. Our findings indicated TA resulted in a reduced intra-, postoperative, and total blood loss by a mean volume of 141.25 mL (95% confidence interval [CI] −186.72 to −95.79, P < 0.00001), 36.42 mL (95% CI −46.50 to −26.34, P < 0.00001), and 154.25 mL (95% CI −182.04 to −126.47, P < 0.00001) in CS. TA administration in VD was associated with a reduced intra-, postoperative, and total blood loss by a mean volume of 22.88 mL (95% CI −50.54 to 4.77, P = 0.10), 41.24 mL (95% CI −55.50 to −26.98, P < 0.00001), and 84.79 mL (95% CI −109.93 to −59.65, P < 0.00001). In addition, TA could lower the occurrence rate of postpartum hemorrhage (PPH) and severe PPH, and reduce the risk of blood transfusions. No increased risk of deep vein thrombosis (DVT) after CS or VD was associated with TA usage, while the minor side effects were more common.Conclusions:Our findings indicated that intravenous TA for patients undergoing CS was effective and safe. Although prophylactic TA administration is associated with reduced PPH, current existing data are insufficient to draw definitive recommendations about its clinical significance due to the poor to moderate quality of the included literatures. Thus, high-quality randomized controlled trials with larger samples are needed to validate our findings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?

Gong

Dong

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…15,16,21,32 Two studies did not adequately detail the criteria used to diagnose PPH and were also excluded from the PPH analysis. 20,29 Among the five studies adhering to the traditional definition of PPH, one study was conducted in SVD patients 24 and four were conducted amongst CS patients. 18,23,25,30 Three studies reported statistically significant reductions in the incidence of PPH associated with TXA use compared to placebo or no treatment.…”

Section: Diagnosis Of Post-partum Hemorrhagementioning

confidence: 99%

“…18,[21][22][23][24][27][28][29] One study assessed the use of TXA during SVD, 24 and 7 others assed its use after CS. 18,[21][22][23][27][28][29] While eight studies reported transfusion outcomes, only 1 had a pre-specified transfusion trigger defined (80 g/L). 21 The other studies did not report objective transfusion triggers.…”

Section: -Hour Peripartum Rbc Transfusion Requirementsmentioning

confidence: 99%

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Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alam

Choi

2015

Transfusion Medicine Reviews

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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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Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial

Cited by 46 publications

References 10 publications

Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?

Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?

Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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