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.
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.
The New England Journal of Medicine
Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery
Loïc Sentilhes et al.
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