Prophylactic use of tranexamic acid along with ecbolic/uterotonic drugs in women who had cesarean delivery significantly lowered excessive bleeding (>1000 ml) or red blood cell transfusion by the 2nd day.

This multicenter, double-blind, randomized, controlled trial aimed to examine the clinical effectiveness of the prophylactic application of tranexamic acid for postpartum blood loss following cesarean section.

Women undergoing cesarean delivery prior to or during labor at 34 gestational weeks or more were randomized to receive a prophylactic ecbolic agent and either tranexamic acid (1 g) intravenously or placebo. The primary outcome was the blood loss of more than 1000 ml or receipt of a red-cell transfusion in 2 days following the delivery, known as postpartum hemorrhage.

The primary outcome data were available for 4153 (93.7%) women out of 4551 women who underwent randomization. About 26.7% in the tranexamic acid group and 31.6% in the placebo group had a postpartum hemorrhage. Thromboembolic events appeared in 0.4% who received tranexamic acid and in 0.1% in placebo in three months after the cesarean delivery, as shown below:

There was no significant difference in case of secondary outcomes (gravimetrically assessed blood loss, provider-assessed clinically noteworthy postpartum hemorrhage, any extra ecbolic drugs, and postpartum blood transfusion) amongst the groups.

The use of tranexamic acid resulted in a significantly lower incidence of postpartum hemorrhage as compared to the placebo, however, it did not lead to a lower frequency of secondary clinical outcomes related to hemorrhage.