An Evaluation Of Prophylactic Tranexamic Acid's Ability To Stop Postpartum Hemorrhage: A Systematic Review

An Evaluation Of Prophylactic Tranexamic Acid's Ability To Stop Postpartum Hemorrhage: A Systematic Review

Authors

  • Mutia Juliana Faculty of Midwifery, General Achmad Yani University, Indonesia

Keywords:

PPH, TXA, maternal, prophylactic, preventing

Abstract

Background: Tranexamic acid (TXA) has been used to treat acute bleeding in trauma-related settings, with low side effects. However, the benefits of prophylactic TXA use remain unclear, raising the possibility of administration before PPH diagnosis. Methods: The study followed the PRISMA 2020 guidelines and developed a systematic review and meta-analysis of blinded and randomized clinical trials to determine the impact of prophylactic TXA use on bleeding volume in cesarean or vaginal deliveries, focusing on English studies. Result: TXA showed significant effects on post-partum bleeding reduction, with lower hemoglobin variation compared to the control group. However, some studies reported mild side effects and the effect was even greater in cesarean delivery. Risk factors for bleeding were considered. Conclusion: Promising outcomes have been observed in lowering blood component requirements and preventing postpartum hemorrhage (PPH) with TXA, a prophylactic treatment for PPH. Even though the use of uterotonics was reduced, a recent multicenter RCT conducted in France was unable to demonstrate a meaningful decline in PPH diagnoses. The study also showed a great deal of variability in TXA use and how it affected cesarean deliveries.

References

Anger H, Durocher J, Dabash R, Winikoff B. How well do post- partum blood loss and common definitions of postpartum hem- orrhage correlate with postpartum anemia and fall in hemoglobin? PLoS ONE. 2019;14:1−13.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: postpartum hemorrhage. Am Coll Obstet Gynecol. 2017;130:168−86.Sheldon WR, Blum J, Vogel JP, Souza JP, Gu€lmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(Suppl 1):5−13.

Assis, I. C., Govêia, C. S., Miranda, D. B., Ferreira, R. S., & Riccio, L. G. C. (2023). Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials. Brazilian journal of anesthesiology (Elsevier), 73(4), 467–476. https://doi.org/10.1016/j.bjane.2022.08.002

Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999−1012.

Say L, Chou D, Gemmill A, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Global Health. 2014;2:323−33.

Magann EF, Evans S, Hutchinson M, Collins R, Lanneau G, Morri- son JC. Postpartum hemorrhage after cesarean delivery: An analysis of risk factors. South Med J. 2005;98:681−5.

Henry DA, Carless PA, Moxey AJ, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007(4):CD001886.

Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other mor- bidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389:2105−16.

Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: A rando- mised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and trans- fusion requirement in bleeding trauma patients. Health Tech- nology Assessment. 2013;17:1−80.

Sentilhes L, Winer N, Azria E, et al. Tranexamic acid for the pre- vention of blood loss after vaginal delivery. N Engl J Med. 2018;379:731−42.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for pre- venting postpartum haemorrhage. Cochrane Database Syst Rev. 2015(6):CD007872.

Milani F, Haryalchi K, Sharami SH, Atrkarroshan Z, Farzadi S. Prophylactic effect of tranexamic acid on hemorrhage during and after the cesarean section. Inter J Women’s Health Repro- duction Scienc. 2019;7:74−8.

Sujita A, Songthamwat S, Songthamwat M. Effectiveness of tra- nexamic acid for reducing postpartum blood loss in the first two hours after vaginal delivery: A randomised controlled trial. J Clin Diagnost Res. 2018;12:QC01−4.

Ismail A, Abbas AM, Shahat. Mohamed A. Evaluation of subendo- metrial and intramyometrial blood flow after intravenous tra- nexamic acid for prevention of postpartum hemorrhage in vaginal delivery: a randomized controlled study. J Gynecol Res Obstet. 2017;3:046−50.

Sujata N, Tobin R, Kaur R, Aneja A, Khanna M, Hanjoora VM. Randomized controlled trial of tranexamic acid among parturi- ents at increased risk for postpartum hemorrhage undergoing cesarean delivery. Inter J Gynecol Obstet. 2016;133:312−5.

Maged AM, Helal OM, Elsherbini MM, et al. A randomized pla- cebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery. Inter J Gynecol Obstet. 2015;131:265−8.

Gungorduk K, Asco glu O, Yldrm G, Ark C, Tekirda g AI, Besmoglu B. Can intravenous injection of tranexamic acid be used in routine practice with active management of the third stage of labor in vaginal delivery? A randomized controlled study. Obstet Gynecol Surv. 2013;68:673−5.

Xu J, Gao W, Ju Y. Tranexamic acid for the prevention of post- partum hemorrhage after cesarean section: A double-blind ran- domization trial. Arch Gynecol Obstet. 2013;287:463−8.

Senturk MB, Cakmak Y, Yildiz G, Yildiz P. Tranexamic acid for cesarean section: A double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet. 2013;287:641−5.

No GG. Prevention and management of postpartum haemorrhage. BJOG. 2017;124:e106−49.

Franchini M, Mengoli C, Cruciani M, et al. Safety and efficacy of tranexamic acid for prevention of obstetric haemorrhage: An updated systematic review and meta-analysis. Blood Transfu- sion. 2018;16:329−37.

Sentilhes L, Winer N, Azria E, et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med. 2018;379:731−42.

Downloads

Published

2024-06-18

How to Cite

An Evaluation Of Prophylactic Tranexamic Acid’s Ability To Stop Postpartum Hemorrhage: A Systematic Review (M. Juliana , Trans.). (2024). The Indonesian Journal of General Medicine, 1(6), 14-24. https://doi.org/10.70070/ywbrq771