Does Tranexamic Acid Prevents Blood Loss After Caesarean Delivery

New study investigated whether tranexamic acid plus a prophylactic uterotonic agent would lower the incidence of postpartum hemorrhage after cesarean delivery.

The use of tranexamic acid did not result in lower incidences of blood loss in women who underwent cesarean delivery and received a prophylactic drug that induced labor to reduce postpartum hemorrhage than placebo.

Postpartum hemorrhage remains a leading cause of severe maternal complications and death worldwide. Tranexamic acid has emerged in the past decade as another candidate drug to prevent blood loss after childbirth.

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‘Among women who underwent cesarean delivery, tranexamic acid treatment did not result in a lower incidence of hemorrhage-related secondary clinical outcomes.’

Tranexamic acid slows the natural breakdown of blood clots by promoting of blocking of lysine-binding sites on plasminogen molecules, and evidence of its clinical effects has been found in various contexts.

In addition, patients who received tranexamic acid had slightly less need for additional medical or surgical interventions to treat postpartum hemorrhage and a slightly lower drop in red blood cell count.

Effect of Tranexamic Acid in Reducing Blood Loss During and After Cesarean Delivery

A new study led by researchers at the University of Texas and appeared in the New England Journal of Medicine examined the association between prophylactic administration of tranexamic acid and reduced postpartum blood loss after cesarean delivery.

These findings differ from those of previous trials, which were smaller and therefore did not have the statistical power to detect a difference in the need for blood transfusion between groups. The current study included participants from 31 birthing centers across the United States and found no benefit from the drug, compared to the placebo.

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Researchers assigned 11,000 patients to receive either intravenous tranexamic acid or a placebo after umbilical cord clamping at the time of cesarean delivery. The study included women who had undergone scheduled and unscheduled cesarean delivery.

They reported the results as a single primary outcome of events that might be expected with postpartum hemorrhage, the need for a transfusion of red blood cells, or death. These events occurred in 201 patients (3.6%) in the tranexamic acid group and 233 (4.3%) in the placebo group, a difference that was not statistically significant.

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For the placebo group, one death occurred. There were no deaths in the tranexamic acid group. There was no significant difference between the groups for the secondary outcome of estimated blood loss of more than 1 liter during the procedure: 7.3% in the tranexamic acid group, and 8% in the placebo group.

However, the study found that patients who received tranexamic acid had less need for additional medical or surgical interventions to treat postpartum hemorrhage, compared to the placebo group (16.1% versus 18%), and a lower drop in red blood cell count after cesarean delivery (1.8 grams per deciliter versus 1.9 grams per deciliter).

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The drug, tranexamic acid, or TXA, which has been used for decades to treat hemophilia, was found safe and effective, reducing the need for a blood transfusion.

The tranexamic acid group was more likely to have an infection after giving birth, 3.2% to 2.5%. The authors noted that previous trials had not seen a difference in infection rates between the groups and added that the finding would need to be confirmed by additional research.

Source-Eurekalert