Li Chunbo, Gong Yuping, Dong Lingling, Xie Bingying, Dai Zhiyuan
Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine Department of Nursing, Zhongshan Hospital of Fudan University Department of Gynaecology and Obstetrics, Gynaecology and Obstetrics Hospital of Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 Jan;96(1):e5653. doi: 10.1097/MD.0000000000005653.
To assess the efficacy and safety of tranexamic acid (TA) in reducing blood loss and lowering transfusion needs for patients undergoing caesarean section (CS) or vaginal delivery (VD).
An electronic literature search of PubMed, EMBASE, OVID, Cochrane library, Scopus, Central, and Clinical trials.gov was performed to identify studies that evaluating the usage of TA in CS or VD. The methodological quality of included trials was assessed and data extraction was performed.
Finally, 25 articles with 4747 participants were included. Our findings indicated TA resulted in a reduced intra-, postoperative, and total blood loss by a mean volume of 141.25 mL (95% confidence interval [CI] -186.72 to -95.79, P < 0.00001), 36.42 mL (95% CI -46.50 to -26.34, P < 0.00001), and 154.25 mL (95% CI -182.04 to -126.47, P < 0.00001) in CS. TA administration in VD was associated with a reduced intra-, postoperative, and total blood loss by a mean volume of 22.88 mL (95% CI -50.54 to 4.77, P = 0.10), 41.24 mL (95% CI -55.50 to -26.98, P < 0.00001), and 84.79 mL (95% CI -109.93 to -59.65, P < 0.00001). In addition, TA could lower the occurrence rate of postpartum hemorrhage (PPH) and severe PPH, and reduce the risk of blood transfusions. No increased risk of deep vein thrombosis (DVT) after CS or VD was associated with TA usage, while the minor side effects were more common.
Our findings indicated that intravenous TA for patients undergoing CS was effective and safe. Although prophylactic TA administration is associated with reduced PPH, current existing data are insufficient to draw definitive recommendations about its clinical significance due to the poor to moderate quality of the included literatures. Thus, high-quality randomized controlled trials with larger samples are needed to validate our findings.
评估氨甲环酸（TA）在减少剖宫产（CS）或阴道分娩（VD）患者失血及降低输血需求方面的有效性和安全性。
对PubMed、EMBASE、OVID、Cochrane图书馆、Scopus、Central和Clinical trials.gov进行电子文献检索，以识别评估TA在CS或VD中使用情况的研究。评估纳入试验的方法学质量并进行数据提取。
最终纳入25篇文章，共4747名参与者。我们的研究结果表明，TA使CS患者术中、术后及总失血量平均减少141.25毫升（95%置信区间[CI] -186.72至-95.79，P<0.00001）、36.42毫升（95% CI -46.50至-26.34，P<0.00001）和154.25毫升（95% CI -182.04至-126.47，P<0.00001）。VD中使用TA使术中、术后及总失血量平均减少22.88毫升（95% CI -50.54至4.77，P = 0.10）、41.24毫升（95% CI -55.50至-26.98，P<0.00001）和84.79毫升（95% CI -109.93至-59.65，P<0.00001）。此外，TA可降低产后出血（PPH）和严重PPH的发生率，并降低输血风险。CS或VD后使用TA与深静脉血栓形成（DVT）风险增加无关，而轻微副作用更常见。
我们的研究结果表明，CS患者静脉使用TA是有效且安全的。尽管预防性使用TA与PPH减少有关，但由于纳入文献质量较差至中等，目前现有数据不足以就其临床意义得出明确建议。因此，需要进行更大样本的高质量随机对照试验来验证我们的研究结果。
