(523) Tranexamic acid prevents postpartum hemorrhage during cesarean delivery: a meta-analysis

Objective: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide, particularly following cesarean delivery. Effective prophylactic interventions are critical to mitigate this risk and improve maternal outcomes. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing blood loss in various surgical contexts. This updated systematic review and meta-analysis aimed to assess the impact of prophylactic tranexamic acid on preventing postpartum hemorrhage and the need for blood transfusion in patients undergoing cesarean delivery.

Study Design: We systematically searched multiple electronic databases and grey literature from their inception up to May 24, 2024, to identify randomized controlled trials (RCTs) that compared prophylactic TXA with placebo or no treatment in patients undergoing cesarean delivery. The primary outcome was postpartum hemorrhage. The need for a blood transfusion was the secondary outcome. We performed a meta-analysis using random-effects models to calculate odds ratios (OR) along with 95% confidence intervals (CI). We also performed an extensive literature review to investigate the cost-effectiveness for the prophylactic TXA at the time of cesarean.

Results: Data from 29 RCTs involving 22,003 participants was collected. The meta-analysis showed that prophylactic TXA in cesarean delivery reduces the risk of postpartum hemorrhage (RR 0.54; 95% CI 0.43-0.67; FI 84) and the need for blood transfusion (RR 0.45; 95% CI 0.34-0.60; FI 63) compared to placebo/no treatment.

Conclusion: Our findings indicate that the use of prophylactic TXA in cesarean delivery reduces the risk of postpartum hemorrhage and the need for blood transfusion. These results support the routine use of prophylactic TXA in cesarean deliveries for individuals at high risk of postpartum hemorrhage.