• Ann Fr Anesth Reanim · Nov 2014

    Review Meta Analysis

    [Efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of post-partum haemorrhage: A systematic review with meta-analysis].

    • D Faraoni, C Carlier, C M Samama, J H Levy, and A S Ducloy-Bouthors.
    • Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique. Electronic address: davidfaraoni@icloud.com.
    • Ann Fr Anesth Reanim. 2014 Nov 1;33(11):563-71.

    Objective(S)Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.Study DesignSystematic review with meta-analysis.Material And MethodsSystematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.ResultsProphylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.ConclusionAlthough tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

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