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

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 We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists to identify additional studies.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.

Conflict of interest statement

Disclosure of conflicts of interest

GML is the Editor-in-Chief of Blood Transfusion and this manuscript has undergone additional external review as a result. The other Authors declare no conflicts of interest.

Figures

Figure 1

Flow chart of study inclusion criteria.

Figure 2

Risk of bias graph and summary. (A) Review authors’ judgements about each risk of bias item presented as percentages across all included studies. (B) Review authors’ judgements about each risk of bias item for each included study.

Figure 3

Forest plot demonstrating effects of tranexamic acid (TA) on the incidence of (A) post-partum haemorrhage and (B) severe post-partum haemorrhage. M-H: Mantel-Haenszel; CI: confidence interval.

Figure 4

Forest plot of the effect of tranexamic acid (TA) on red blood cell (RBC) transfusion need. M-H: Mantel-Haenszel; CI: confidence interval.

Figure 5

Forest plot of tranexamic acid (TA) on post-partum blood loss (mL). CI: confidence interval.