Review

Blood Transfusion - 4 2018 (July - August)

Safety and efficacy of tranexamic acid for prevention of obstetric haemorrhage: an updated systematic review and meta-analysis

Authors

Key words: obstetric haemorrhage, post-partum haemorrhage, tranexamic acid, bleeding, prevention
Publication Date: 2018-04-03

Abstract

Background. A number of clinical systematic review and meta-analysis have been published on the use of tranexamic in the obstetric setting. The aim of this meta-analysis was to evaluate the safety and effectiveness of tranexamic acid in reducing blood loss when given prior to caesarean delivery.
Materials and methods. We searched the Cochrane Wounds Specialized Register, Cochrane Central, MEDLINE (through PUBMED), Embase, and SCOPUS electronic databases. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists to identify additional studies. We used no restrictions with respect to language and date of publication. Two review authors independently performed study selection, "Risk of bias" assessment, and data extraction. Initial disagreements were resolved by discussion, or by including a third review author when necessary.
Results. We found 18 randomised controlled trials (RCTs) that met our inclusion criteria. Overall, 1,764 women receiving intravenous tranexamic acid for prevention of bleeding following caesarean sections and 1,793 controls receiving placebo were enrolled in the 18 RCTs evaluated. The use of tranexamic acid compared to controls (placebo or no intervention) reduces post-partum haemorrhage >400 mL (risk ratio [RR] 0.40, 95% confidence interval [CI] 0.24-0.65; 5 trials with a total of 786 participants), severe post-partum haemorrhage >1,000 mL (RR 0.32, 95% CI: 0.12-0.84; 5 trials with a total of 1,850 participants), and need for red blood cell transfusion (RR 0.30, 95% CI: 0.18-0.49; 10 trials with a total of 1,873 participants). No particular safety concerns on the use of this antifibrinolytic agent emerged from the analysis of the 18 RCTs included.
Discussion. Overall, the results of this meta-analysis support the evidence of a beneficial effect of tranexamic acid in reducing blood loss and need for blood transfusion in pregnant women undergoing caesarean section.

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Authors

Massimo Franchini - Italian National Blood Centre, National Institute of Health, Rome; Department of Haematology and Transfusion Medicine, "Carlo Poma" Hospital, Mantua

Carlo Mengoli - Italian National Blood Centre, National Institute of Health, Rome

Mario Cruciani - Infection Control Committee, AULSS9 "Scaligera", Verona

Valentino Bergamini - Department of Obstetrics and Gynecology, "Azienda Ospedaliera Universitaria Integrata", Verona

Francesca Presti - Department of Obstetrics and Gynecology, "Azienda Ospedaliera Universitaria Integrata", Verona

Giuseppe Marano - Italian National Blood Centre, National Institute of Health, Rome

Simonetta Pupella - Italian National Blood Centre, National Institute of Health, Rome

Stefania Vaglio - Italian National Blood Centre, National Institute of Health, Rome; Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Rome, Italy

Francesca Masiello - Italian National Blood Centre, National Institute of Health, Rome

Eva Veropalumbo - Italian National Blood Centre, National Institute of Health, Rome

Vanessa Piccinini - Italian National Blood Centre, National Institute of Health, Rome

Ilaria Pati - Italian National Blood Centre, National Institute of Health, Rome

Giancarlo M. Liumbruno - Italian National Blood Centre, National Institute of Health, Rome

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