Tranexamic acid for the prevention and the treatment of primary postpartum haemorrhage: a systematic review

Abstract

Tranexamic acid (TA) has been proposed for preventing or treating primary postpartum haemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. We conducted a systematic literature search to the TA role in managing PPH in vaginal and caesarean delivery. Twenty-seven randomised controlled trials (RCTs) (33,302 women) were identified. Three RCTs investigated TA for preventing PPH after vaginal delivery and 22 after caesarean section. None demonstrated a preventive effect on secondary clinical outcomes related to blood loss. Two trials evaluated TA for treating PPH after vaginal and caesarean delivery. Only the WOMAN trial showed that 1 g of TA is effective. In conclusion, TA is considered useful and is recommended or advised for treating PPH. Conversely, available evidence on the prophylactic role is still limited, and this use is not supported. Further investigation is recommended. In this regard, stronger and more reliable outcomes than blood loss should be considered.

Keywords:

• Tranexamic acid
• vaginal delivery
• caesarean section
• postpartum haemorrhage
• obstetric care

Author contributions

All the authors conform to the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, contributed to the intellectual content of the study, and gave approval for the final version of the article. MF, FG, SU and AC: study conceptualisation. MF, FG, SU and AC: study design. FAF, SG, RR, JC and MF: review of the literature. MF, FG, SU and AC: project administration, methodology validation and supervision. FAF, SG and SU: manuscript writing/editing. All authors contributed to the interpretation of results, as well as to the writing and editing of the manuscript.

Disclosure statement

All the authors have no conflict of interest to declare.

Data availability statement

All data are fully available without restriction within the manuscript.