Tranexamic acid for the prevention and treatment of postpartum hemorrhage : a review

Abstract

Background : Postpartum hemorrhage (PPH) is a frequent complication and a major cause of maternal death. PPH can be due to retained placenta, uterine atony, genital tract trauma or coagulopathy. Tranexamic acid (TA), an anti-fibrinolytic agent, can be useful to prevent or treat PPH. In this review, the effectiveness and safety of TA was evaluated.

Methods : Randomized trials comparing TA and placebo in women undergoing vaginal or cesarean delivery were identified. The distinction between the use of TA as a prophylactic or a therapeutic agent was made. The primary outcome in most studies was estimated blood loss during and after delivery. The secondary outcomes were the need for blood transfusion, changes in hemoglobin concentration, the incidence of PPH, side effects and possible complications of TA.

Results : Nine randomized trials involving a total of 25,815 women were included. Most trials were small, except for the TRAAP and the WOMAN trial. As a prophylaxis, TA decreased blood loss during and after childbirth, but not the need for blood transfusion. Used for therapy of PPH, TA reduced death due to bleeding. Side effects of TA, such as nausea and vomiting were mild and reversible. There was no difference in the incidence of thromboembolic events between TA and placebo.

Conclusion : TA has a place in the therapy of PPH when given as soon as possible. The effect as a prophylaxis of PPH is less clear. Additional trials are needed to determine the optimal dose and use of TA. However, TA is a cheap agent, complications are minor, and There is no increased incidence of thromboembolic events.