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The Journal of Maternal-Fetal & Neonatal Medicine Volume 33, 2020 - Issue 5
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Review Article

Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials

Luigi Della CorteDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
,
Gabriele SacconeDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy; Correspondence[email protected]
ORCID Iconhttp://orcid.org/0000-0003-0078-2113
ORCID Icon,
Mariavittoria LocciDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
,
Luigi CarboneDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
,
Antonio RaffoneDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
,
Pierluigi GiampaolinoDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
,
Andrea CiardulliDepartment of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy;
,
Vincenzo BerghellaDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA
&
Fulvio ZulloDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy;
show all
Pages 869-874 | Received 09 Apr 2018, Accepted 10 Jul 2018, Published online: 10 Sep 2018
 
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Abstract

Background: Postpartum hemorrhage (PPH) is responsible for about 25% of maternal deaths worldwide. Antifibrinolytic agents, mainly tranexamic acid (TXA), have been demonstrated to reduce blood loss in patients with established PPH.

Objective: The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of TXA administration in women with established primary PPH after vaginal delivery.

Data sources: The search was conducted using electronic databases from inception of each database through February 2018. Review of articles also included the abstracts of all references retrieved from the search. No restrictions for language or geographic location were applied.

Study design: Selection criteria included RCTs comparing the use of TXA in women with established primary PPH after vaginal delivery with control (either placebo or no treatment). Trials in women undergoing cesarean delivery and trials in prevention of PPH were excluded. The primary outcome was the incidence of hysterectomy. The summary measures were reported as summary relative risk (RR) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird.

Tabulation, integration, and results: Two trials including 14,363 women with established primary PPH after vaginal delivery were analyzed. Women who received TXA soon after the diagnosis of PPH had a significantly lower incidence of hysterectomy (0.5% vs 0.8%; RR 0.63, 95% CI 0.42–0.94), compared to those who did not. The risk of thrombotic events was not increased in the TXA group.

Conclusion: In women with established PPH after vaginal delivery, the use of TXA reduces the risk of hysterectomy and does not increase the risk of thrombotic events. We recommend 1 g plus a second dose of 1 g if bleeding continues after 30 min.

Disclosure statement

No potential conflict of interest was reported by the authors.

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