Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials

Assis, Ivo de C.; Govêia, Catia S.; Miranda, Denismar B.; Ferreira, Rafael S.; Riccio, Luiza G.C.

doi:10.1016/j.bjane.2022.08.002

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Brazilian Journal of Anesthesiology

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Sumário

Systematic Review • para Braz. J. Anesthesiol. 73 (4) • Jul-Aug 2023 • https://doi.org/10.1016/j.bjane.2022.08.002 copy

Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Postpartum Hemorrhage (PPH) is one of the main causes of maternal mortality, mainly in the poorest regions of the world, drawing attention to the need for strategies for preventing it. This study aims to evaluate the efficacy of prophylactic administration of Tranexamic Acid (TXA) in decreasing blood loss in pregnant women in delivery, preventing PPH.

Methods

Systematic review of randomized clinical trials. We searched for publications in PubMed, EMBASE and Cochrane Library databases, with the uniterms “postpartum, puerperal hemorrhage” and “tranexamic acid”, published between January of 2004 and January of 2020. The eligibility criteria were trials published in English with pregnant women assessed during and after vaginal or cesarean delivery about the effect of prophylactic use of TXA on bleeding volume. The random-effects model was applied with the DerSimonian-Laird test and the Mean Difference (MD) was calculated for continuous variables together with each 95% CI. This systematic review was previously registered in the PROSPERO platform under the registration n° CRD42020187393.

Results

Of the 630 results, 16 trials were selected, including one with two different doses, performing a total of 6731 patients. The intervention group received a TXA dose that varied between 10 mg.kg⁻¹ and 1g (no weight calculation). The TXA use was considered a protective factor for bleeding (MD: -131.07; 95% CI: -170.00 to -92.78; p= 0.000) and hemoglobin variation (MD: -0.417; 95% CI: -0.633 to -0.202; p= 0.000). In the subgroup analysis related to the cesarean pathway, the effect of TXA was even greater.

Conclusion

The prophylactic use of tranexamic acid is effective in reducing the post-partum bleeding volume.

PROSPERO registration ID

CRD42020187393.

KEYWORDS
Postpartum hemorrhage; Prophylaxis; Tranexamic acid

Autor	Year	Country	Type of delivery	TXA Dose	Control	Patients TXA (n)	Patients Control (n)	Type of anesthesia (cesarean)
Gungorduk et al.	2011	Turkey	Cesarean	1g, 10 min before incision	30 mL glucose 5%	330	330	Non described
Movafegh et al.	2011	Iran	Cesarean	10 mg.kg⁻¹, 20 min before anesthesia	Saline IV	50	50	Spinal
Sentürk et al.	2012	Turkey	Cesarean	1 g, 5 min before incision	Dextrose 5%	101	122	Spinal
Gungorduk et al.	2013	Turkey	Vaginal	1 g, for 5 min after extracting the anterior shoulder	30 mL glucose 5%	220	219	‒
Xu et al.	2013	China	Cesarean	10 mg.kg⁻¹+ 200 mL saline	200 mL saline	88	86	Spinal
Goswami et al. A	2013	India	Cesarean	10 mg.kg⁻¹+ 20 mL dextrose 5%	5 mL DW + 20 mL dextrose 5%	30	30	Spinal
Goswami et al. B	2013	India	Cesarean	15 mg.kg⁻¹+ 20 mL dextrose 5%	5 mL DW + 20 mL de dextrose 5%	30	30	Spinal
Shahid et al.	2013	Pakistan	Cesarean	1g + 20 mL glucose 5%	10 mL DW + 20 mL glucose 5%	38	36	Spinal
Ghosh et al.	2014	India	Cesarean	1g	10 mL DW	70	70	Spinal
Maged et al.	2015	Egypt	Cesarean	1g	30 mL glucose 5%	100	100	Non described
Mirghafourvand et al.	2015	Iran	Vaginal	1g, after extracting the anterior shoulder	DW	60	60	‒
Sujata et al.^a a This trial was not included in the meta-analysis because lack of data; IV, Intravenous; DW, Distilled Water; A and B, In Goswami et al. the analysis was divided into two groups because two different doses of TXA were used (10 mg.kg−1 and 15 mg.kg−1).	2016	India	Cesarean	10 mg.kg⁻¹	Saline IV	30	30	Non described
Ismail et al.	2017	Egypt	Vaginal	1g, soon after delivery	30 mL glucose 5%	100	100	‒
Abbas et al.	2018	Egypt	Cesarean	1g before incision	Saline IV	31	31	General
Sentilhes et al.	2018	France	Vaginal	1g, 2 min after delivery	Saline IV	1931	1927	‒
Sujita et al.	2018	Thailand	Vaginal	1g + 20 mL saline (30 mL total)	30 mL saline	72	69	‒
Millani et al.	2019	Iran	Cesarean	1g + 20 mL of DW, 15 min before incision	Glucose 5% 10 mL + 20 mL DW	30	30	Spinal
Shah et al.	2019	Nepal	Cesarean	1g	10 mL saline	80	80	Non described

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail:ivo_assis@hotmail.com (I.C. Assis).