• Henrique Provinciatto, Maria E Barbalho, Pedro M da Câmara, Isabelle B Donadon, Luiza M Fonseca, Marina S Bertani, Alice D Marinho, Eduardo Sirena, Alexandre Provinciatto, and Sara Amaral.
• Barao de Maua University Center, Avenida Portugal, 2433, Ribeirao Preto, SP, Brazil. henriquegprovinciatto@gmail.com.
• Can J Anaesth. 2024 Apr 1; 71 (4): 465478465-478.

PurposePostpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Although several studies on the prophylactic use of tranexamic acid (TXA) in parturients undergoing Cesarean delivery have been published, conflicting results raise questions regarding its use. Thus, we aimed to investigate the safety and efficacy of PPH prophylaxis with TXA.SourceWe searched PubMed®, Embase, Cochrane Central, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing prophylactic TXA with placebo or no treatment in parturients undergoing Cesarean delivery. Our main outcomes were PPH, any blood transfusion, need for additional uterotonics, and adverse events. We performed a trial sequential analysis (TSA) of all outcomes to investigate the reliability and conclusiveness of findings.Principal FindingsWe included 38 RCTs including 22,940 parturients, 11,535 (50%) of whom were randomized to receive prophylactic TXA. Patients treated with TXA had significantly fewer cases of PPH (risk ratio [RR], 0.51; 95% confidence interval [CI], 0.38 to 0.69; P < 0.001); less blood transfusion (RR, 0.43; 95% CI, 0.30 to 0.61; P < 0.001), and less use of additional uterotonics (RR, 0.52; 95% CI, 0.40 to 0.68; P < 0.001). No significant differences were found between the groups in terms of adverse effects and thromboembolic events.ConclusionProphylactic TXA administration for parturients undergoing Cesarean delivery significantly reduced blood loss, without increasing adverse events, supporting its use as a safe and effective strategy for reducing PPH in this population.Study RegistrationPROSPERO (CRD42023422188); first submitted 27 April 2023.© 2024. Canadian Anesthesiologists' Society.

15 keywords...

hide…