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...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-023-05753-9 |
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| author | Fan Yang Han Wang Mengdie Shen |
| author_facet | Fan Yang Han Wang Mengdie Shen |
| author_sort | Fan Yang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T06:07:12Z |
| format | Article |
| id | doaj.art-4cd77687563544cba8fd39d9a3cd4951 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-13T06:07:12Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4cd77687563544cba8fd39d9a3cd49512023-06-11T11:28:05ZengBMCBMC Pregnancy and Childbirth1471-23932023-06-0123111610.1186/s12884-023-05753-9Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysisFan Yang0Han Wang1Mengdie Shen2Department of Intensive Care Unit, Women’s Hospital, School of Medicine, Zhejiang UniversityDepartment of Gynecology and Obstetrics, Women’s Hospital, School of Medicine, Zhejiang UniversityDepartment of Internal Medicine, Women’s Hospital, School of Medicine, Zhejiang UniversityAbstract 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.https://doi.org/10.1186/s12884-023-05753-9Tranexamic acidPostpartum hemorrhageCesarean delivery |
| spellingShingle | Fan Yang Han Wang Mengdie Shen Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis BMC Pregnancy and Childbirth Tranexamic acid Postpartum hemorrhage Cesarean delivery |
| title | Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis |
| title_full | Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis |
| title_fullStr | Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis |
| title_full_unstemmed | Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis |
| title_short | Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis |
| title_sort | effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery a systematic review and meta analysis |
| topic | Tranexamic acid Postpartum hemorrhage Cesarean delivery |
| url | https://doi.org/10.1186/s12884-023-05753-9 |
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