Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials

a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy. b Department of Obstetrics and Gynecology , Catholic University of the Sacred Heart , Rome , Italy. c Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , Pennsylvania , USA. a Department of Neuroscience , Reproductive Sciences and Dentistry , School of Medicine , University of Naples "Federico II" , Naples , Italy.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018;:1-11.
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PICO Summary

Population

Women with primary postpartum haemorrhage (PPH) after vaginal delivery (2 studies, n= 14,363).

Intervention

Tranexamic acid (TXA), (n= 7,165).

Comparison

Placebo or no treatment (n= 7,198).

Outcome

Women who received TXA soon after the diagnosis of PPH had a significantly lower incidence of hysterectomy (0.5% vs 0.8%; RR 0.63, 95% CI 0.42-0.94), compared to those who did not. The risk of thrombotic events was not increased in the TXA group.
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is responsible for about 25% of maternal deaths worldwide. Antifibrinolytic agents, mainly tranexamic acid, have been demonstrated to reduce blood loss in patients with established PPH Objective: The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of tranexamic acid administration in women with established primary PPH after vaginal delivery. DATA SOURCES The search was conducted using electronic databases from inception of each database through February 2018. Review of articles also included the abstracts of all references retrieved from the search. No restrictions for language or geographic location were applied. STUDY DESIGN Selection criteria included RCTs comparing the use of tranexamic acid in women with established primary PPH after vaginal delivery with control (either placebo or no treatment). Trials in women undergoing cesarean delivery and trials in prevention of PPH were excluded. The primary outcome was the incidence of hysterectomy. The summary measures were reported as summary relative risk (RR) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird. TABULATION, INTEGRATION, AND RESULTS Two trials including 14 363 women with established primary PPH after vaginal delivery were analyzed. Women who received tranexamic acid soon after the diagnosis of PPH had a significantly lower incidence of hysterectomy (0.5 versus 0.8%; RR 0.63, 95% CI 0.42-0.94), compared to those who did not. The risk of thrombotic events was not increased in the tranexamic acid group. CONCLUSION In women with established PPH after vaginal delivery, use of tranexamic acid reduces the risk of hysterectomy and does not increase the risk of thrombotic events. We recommend 1 g plus a second dose of 1 g if bleeding continues after 30 min.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine