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Meta-Analysis
. 2023 Nov 24;23(1):817.
doi: 10.1186/s12884-023-06100-8.

Efficacy and safety of tranexamic acid in prevention of postpartum hemorrhage: a systematic review and meta-analysis of 18,649 patients

Nada Mostafa Al-Dardery  1   2 , Omar Ahmed Abdelwahab  2   3 , Mohamed Abouzid  4   5 , Khaled Albakri  2   6 , Ali Elkhadragy  2   7 , Basant E Katamesh  8 , Rawan Hamamreh  6 , Ahmed B Mohd  6 , Ahmed Abdelaziz  2   3 , Abdulrhman Khaity  9   10
Affiliations
Meta-Analysis

Efficacy and safety of tranexamic acid in prevention of postpartum hemorrhage: a systematic review and meta-analysis of 18,649 patients

Nada Mostafa Al-Dardery et al. BMC Pregnancy Childbirth. .

Abstract

Background: In this meta-analysis, we aimed to update the clinical evidence regarding the efficacy and safety of TXA in the prevention of PPH.

Methods: A literature search of PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library from inception until December 2022 was conducted. We included randomized controlled trials (RCTs) comparing TXA with a placebo among pregnant women. All relevant outcomes, such as total blood loss, the occurrence of nausea and/or vomiting, and changes in hemoglobin, were combined as odds ratios (OR) or mean differences (MD) in the meta-analysis models using STATA 17 MP.

Results: We included 59 RCTs (18,649 patients) in this meta-analysis. For cesarean birth, TXA was favored over the placebo in reducing total blood loss (MD= -2.11 mL, 95%CI [-3.09 to -1.14], P < 0.001), and occurrence of nausea or/and vomiting (OR = 1.36, 95%CI [1.07 to 1.74], P = 0.01). For vaginal birth, the prophylactic use of TXA was associated with lower total blood loss, and higher occurrence of nausea and/or vomiting (MD= -0.89 mL, 95%CI [-1.47 to -0.31], OR = 2.36, 95%CI [1.32 to 4.21], P = 0.02), respectively. However, there were no differences between the groups in changes in hemoglobin during vaginal birth (MD = 0.20 g/dl, 95%CI [-0.07 to 0.48], P = 0.15). The overall risk of bias among the included studies varies from low to high risk of bias using ROB-II tool for RCTs.

Conclusions: This meta-analysis suggested that TXA administration is effective among women undergoing cesarean birth or vaginal birth in lowering total blood loss and limiting the occurrence of PPH. Further clinical trials are recommended to test its efficacy on high-risk populations.

Keywords: Cesarean birth; Postpartum hemorrhage; Tranexamic acid; Vaginal birth.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies’ screening and selection
Fig. 2
Fig. 2
Forest plots of mean difference in total blood loss in CB
Fig. 3
Fig. 3
Forest plots of mean difference in change in HB in CB
Fig. 4
Fig. 4
Forest plot of odd ratios in occurrence of PPH in CB
Fig. 5
Fig. 5
Forest plots of mean difference in A total blood loss in VB, B Change in HB in VB, and Forest plot of odd ratios in C Occurrence of PPH in VB
See this image and copyright information in PMC

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