Tranexamic acid for preventing postpartum haemorrhage

The Cochrane Collaboration
Cochrane Reviews
 

Tranexamic acid for preventing postpartum haemorrhage

Novikova N, Hofmeyr GJ

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Summary

Tranexamic acid for preventing bleeding after delivery

Tranexamic acid is used to decrease blood loss in surgery and health conditions associated with increased bleeding. This review found that tranexamic acid is also effective in the reduction of blood loss after a mother gives birth. One study of 400 women (273 women were included in the analysis for purpose of this review), compared use of tranexamic acid in two different doses (1 g and 0.5 g given intravenously) to no such treatment. Tranexamic acid was given two to three minutes after the vaginal delivery of the baby, which is when the mother is most at a risk of excessive bleeding related to the childbirth. In the second study of 180 women, the use of tranexamic acid was compared with no treatment in women who were undergoing caesarean section. Tranexamic acid was given 10 minutes before incision. In both studies mean blood loss was lower in women who received tranexamic acid compared to women who did not. The higher dose of tranexamic acid tended to cause mild side effects such as nausea and vomiting for a very few of the women. Women who received a lower dose of tranexamic acid had no side effects. More research is needed.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 8, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Novikova N, Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD007872. DOI: 10.1002/14651858.CD007872.pub2

Editorial Group: Pregnancy and Childbirth Group

This version first published online: July 7. 2010
Last assessed as up-to-date: March 12. 2010

Abstract

Background

Postpartum haemorrhage (PPH) is a common and occasionally life-threatening complication of labour. Several options for preventing PPH are available, but further advances in this field are important, especially the identification of safe, easy to use, and cost-effective regimes. Tranexamic acid, which is an antifibrinolytic that is used widely to prevent and treat haemorrhage, merits evaluation to assess whether it meets these criteria.

Objectives

To determine, from the best available evidence, whether tranexamic acid is effective for preventing PPH.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (12 September 2009).

Selection criteria

All published, unpublished and ongoing randomised controlled trials (RCTs) evaluating the use of tranexamic acid alone or in addition to uterotonics in the third stage of labour or during caesarean section to prevent PPH.

Data collection and analysis

Two review authors independently assessed for inclusion all the potential studies identified as a result of the search strategy. We entered the data into Review Manager software and checked for accuracy.

Main results

We included two RCTs. One RCT of unclear quality of 273 women compared tranexamic acid in two doses (0.5 g intravenously and 1 g intravenously) with aminomethylbenzoic acid (0.5 g intravenously) and with no treatment in women who had vaginal birth. We excluded the aminomethylbenzoic acid arm of this trial (92 patients).

Another RCT of 180 women who underwent caesarean section compared tranexamic acid (1 g intravenously given 10 minutes before incision) with placebo.

Blood loss greater than 400 ml was less common in women who received tranexamic acid after vaginal birth or caesarean section in the dosage of 1 g or 0.5 g intravenously (two studies, 453 women, risk ratio (RR) 0.51, 95% confidence interval (CI) 0.36 to 0.72). Mean blood loss was lower in the group of women who received intravenous tranexamic acid postpartum (two studies, 361 women, mean difference (MD) -75.17 ml, 95% CI -108.23 ml to -42.12 ml).

No serious side effects were reported in women who received tranexamic acid in these trials.

Authors' conclusions

Tranexamic acid decreases postpartum blood loss after vaginal birth and after caesarean section based on two RCTs of unclear quality which reported on only a few outcomes. Further investigations are needed on efficacy and safety of this regimen for preventing PPH.

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