Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis

Abstract

Background: Postpartum hemorrhage (PPH) is one of the important risk factors leading to maternal mortality and intervention is essential. Oxytocin therapy is widely used clinically, but the effect is unsatisfactory. The efficacy of tranexamic acid (TXA) in hemostasis is notable, whereas its use in preventing PPH warrants exploration.

Aims: To evaluate the effect of prophylactic administration of TXA on perioperative blood loss in women undergoing cesarean section by systematic review and meta-analysis of published studies.

Methods: Bibliographic databases were screened from their inception to December 2022 to retrieve relevant studies. Study outcomes including blood loss during cesarean section, 2-h postpartum blood loss, total blood loss (during cesarean section and 2-h postpartum), and 6-h postpartum, as well as hemoglobin changes were extracted and compared.

Results: A total of 21 studies, nine randomized clinical trials and 12 cohort studies, involving 1896 patients given TXA prophylactically and 1909 patients given placebo or no treatment, were analyzed. Compared with the control group, the preoperative prophylactic intravenous administration of TXA significantly reduced the intraoperative (RCT: P < 0.00001, cohort studies: P < 0.00001), 2-h postpartum (RCT: P = 0.02, cohort studies: P < 0.00001) and total blood loss (RCT: P < 0.00001, cohort studies: P = 0.0002), and reduced the decline in hemoglobin (RCT: P < 0.00001, cohort studies: P = 0.0001), but did not significantly affect blood loss at 6-h postpartum (P = 0.05).

Conclusion: Prophylactic intravenous TXA before cesarean section is helpful in preventing perioperative bleeding in women.

Trial registration: http://www.crd.york.ac.uk/PROSPERO , identifier: CRD 42022363450.

Keywords: Cesarean delivery; Postpartum hemorrhage; Tranexamic acid.

Fig. 1

Study flow diagram. Records were identified through database searches and grey literature. A total of 108 articles met the criteria for full-text review, and 21 of them were finally included in the meta-analysis

Fig. 2

Risk of bias summary and graph showing authors’ judgements about each risk of bias item for RCTs

Fig. 3

Forest plot diagram showing the effect of prophylactic TXA use before cesarean section on intraoperative blood loss, 2-h postpartum blood loss and total blood loss

Fig. 4

Forest plot diagram showing the effect of prophylactic TXA use before cesarean section on 6-h postpartum blood loss and hemoglobin change