Ferrer Pili, Roberts Ian, Sydenham Emma, Blackhall Karen, Shakur Haleema
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
BMC Pregnancy Childbirth. 2009 Jul 15;9:29. doi: 10.1186/1471-2393-9-29.
Post partum haemorrhage is a leading cause of maternal death worldwide. It also contributes to maternal morbidity as women may require a hysterectomy to control bleeding, or may require a blood transfusion, which can transmit viral infections. Anti-fibrinolytic agents have been proposed as a treatment for post partum haemorrhage. We conducted a systematic review to assess the effectiveness and safety of anti-fibrinolytic agents in post partum bleeding.
All randomised controlled trials of anti-fibrinolytic agents given for bleeding during the postpartum period were included in this review. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled trials, Web of Science, metaRegister of controlled trials, LILACS, Reproductive Health Library, African healthline, POPLINE, MedCarib, CINAHL, Clinicaltrials.gov and the reference lists of eligible trials. Two authors extracted data. Methodological quality was assessed by evaluating allocation concealment. The primary outcome was maternal mortality. Secondary outcomes were blood loss, blood transfusion, hysterectomy, mean haemoglobin concentration, thrombo-embolic events and other adverse effects.
We identified three randomised controlled trials involving 461 participants. The trials compared tranexamic acid with no treatment and reported blood loss after delivery. In all three trials, allocation concealment was either inadequate or unclear. The administration of tranexamic acid was associated with a reduction in blood loss of 92 millilitres (95%CI 76 to 109). The most frequently reported adverse effect of tranexamic acid was nausea, although the increase was easily compatible with the play of chance (RR 4.63, 95%CI 0.23 to 95.14).
Tranexamic acid may reduce blood loss in post partum haemorrhage. However, the quality of the currently available evidence is poor. Adequately powered, high quality randomised controlled trials are needed.
产后出血是全球孕产妇死亡的主要原因。它还会导致孕产妇发病，因为女性可能需要进行子宫切除术来控制出血，或者可能需要输血，而输血可能会传播病毒感染。抗纤维蛋白溶解剂已被提议用于治疗产后出血。我们进行了一项系统评价，以评估抗纤维蛋白溶解剂在产后出血中的有效性和安全性。
本评价纳入了所有关于产后期间使用抗纤维蛋白溶解剂治疗出血的随机对照试验。我们检索了医学期刊数据库、PubMed、EMBASE、Cochrane对照试验中央注册库、科学网、对照试验元注册库、拉丁美洲和加勒比卫生科学数据库、生殖健康图书馆、非洲健康热线、人口在线、加勒比医学数据库、护理学与健康领域数据库、Clinicaltrials.gov以及符合条件试验的参考文献列表。两名作者提取数据。通过评估分配隐藏情况来评估方法学质量。主要结局是孕产妇死亡率。次要结局包括失血量、输血、子宫切除术、平均血红蛋白浓度、血栓栓塞事件和其他不良反应。
我们确定了三项随机对照试验，涉及461名参与者。这些试验比较了氨甲环酸与不治疗，并报告了分娩后的失血量。在所有三项试验中，分配隐藏情况要么不充分，要么不明确。氨甲环酸的使用与失血量减少92毫升相关（95%置信区间为76至109）。氨甲环酸最常报告的不良反应是恶心，尽管这种增加很可能是由偶然因素导致的（风险比率4.63，95%置信区间为0.23至95.14）。
氨甲环酸可能会减少产后出血的失血量。然而，目前现有证据的质量较差。需要开展有足够样本量的高质量随机对照试验。
