Tranexamic acid for preventing bleeding after delivery

Novikova N, Hofmeyr GJ

Published Online:

July 6, 2011

Tranexamic acid is used to decrease blood loss in surgery and health conditions associated with increased bleeding. This review found that tranexamic acid is also effective in reducing blood loss after a mother gives birth. One study of 400 women (273 women were included in the analysis for purpose of this review), compared use of tranexamic acid in two different doses (1 g and 0.5 g given intravenously) to no such treatment. Tranexamic acid was given two to three minutes after the vaginal delivery of the baby, which is when the mother is most at a risk of excessive bleeding related to the childbirth. In another study (involving 180 women), the use of tranexamic acid was compared with no treatment in women who were undergoing caesarean section. Tranexamic acid was given 10 minutes before incision. The mean blood loss was lower in women who received tranexamic acid compared to women who did not. The higher dose of tranexamic acid tended to cause mild side effects such as nausea and vomiting for a very few of the women. Women who received a lower dose of tranexamic acid had no side effects. More research is needed.

Abstract (click to read)

Background:

Postpartum haemorrhage (PPH) is a common and occasionally life-threatening complication of labour. Several options for preventing PPH are available, but further advances in this field are important, especially the identification of safe, easy to use and cost-effective regimes. Tranexamic acid, which is an antifibrinolytic that is used widely to prevent and treat haemorrhage, merits evaluation to assess whether it meets these criteria. Evidence of effectiveness in preventing PPH might also be extrapolated to use for treatment of PPH (as have other preventive measures).

Objectives:

To determine, from the best available evidence, whether tranexamic acid is effective for preventing PPH.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (15 February 2011).

Selection criteria:

All published, unpublished and ongoing randomised controlled trials (RCTs) evaluating the use of tranexamic acid alone or in addition to uterotonics in the third stage of labour or during caesarean section to prevent PPH.

Data collection and analysis:

Two review authors independently assessed for inclusion all the potential studies identified as a result of the search strategy. We entered the data into Review Manager software and checked for accuracy.

Main results:

We included two RCTs. One RCT of unclear quality (involving 273 women) compared tranexamic acid in two doses (0.5 g intravenously and 1 g intravenously) with aminomethylbenzoic acid (0.5 g intravenously) and with no treatment in women who had vaginal birth. We excluded the aminomethylbenzoic acid arm of this trial (92 women). A second RCT of 180 women who underwent caesarean section compared tranexamic acid (1 g intravenously given 10 minutes before incision) with placebo.

Blood loss greater than 400 ml was less common in women who received tranexamic acid after vaginal birth or caesarean section in the dosage of 1 g or 0.5 g intravenously (risk ratio (RR) 0.51; 95% confidence interval (CI) 0.36 to 0.72; two studies, 453 women). Mean blood loss was lower in the group of women who received intravenous tranexamic acid postpartum (mean difference (MD) -75.17 ml; 95% CI -108.23 ml to -42.12 ml; two studies, 361 women).

No serious side effects were reported in women who received tranexamic acid in the three included studies.

Authors' conclusions:

Tranexamic acid decreases postpartum blood loss after vaginal birth and after caesarean section based on two RCTs of unclear quality which reported on only a few outcomes. Further investigations are needed to confirm efficacy and safety of this regimen for preventing PPH. These results also provide a basis for the investigation of tranexamic acid for the treatment of PPH.

This record should be cited as:

Novikova N, Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD007872. DOI: 10.1002/14651858.CD007872.pub2

Assessed as up to date:

May 12, 2011

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Care during childbirth > Normal labour & birth

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tranexamic acid for preventing bleeding after delivery

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