Barao de Maua University Center, Avenida Portugal, 2433, Ribeirao Preto, SP, Brazil.
Potiguar University, Natal, Brazil.
Can J Anaesth. 2024 Apr;71(4):465-478. doi: 10.1007/s12630-024-02715-3. Epub 2024 Mar 7.
Postpartum 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.
We 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.
We 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.
Prophylactic 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.
PROSPERO (CRD42023422188); first submitted 27 April 2023.
产后出血（PPH）是全球产妇死亡的主要原因。尽管已经发表了多项关于在接受剖宫产的产妇中预防性使用氨甲环酸（TXA）的研究，但结果相互矛盾，这使得其使用受到质疑。因此，我们旨在研究 TXA 预防性治疗 PPH 的安全性和有效性。
我们在 PubMed、Embase、Cochrane 中心和 ClinicalTrials.gov 中检索了比较在接受剖宫产的产妇中预防性使用 TXA 与安慰剂或不治疗的随机对照试验（RCT）。我们的主要结局是 PPH、任何输血、需要额外使用宫缩剂和不良事件。我们对所有结局进行了试验序贯分析（TSA），以调查结果的可靠性和结论性。
我们纳入了 38 项 RCT，共纳入 22940 名产妇，其中 11535 名（50%）被随机分配接受预防性 TXA 治疗。接受 TXA 治疗的患者 PPH 发生率显著降低（风险比 [RR]，0.51；95%置信区间 [CI]，0.38 至 0.69；P<0.001）；输血减少（RR，0.43；95%CI，0.30 至 0.61；P<0.001），以及额外使用宫缩剂减少（RR，0.52；95%CI，0.40 至 0.68；P<0.001）。两组在不良反应和血栓栓塞事件方面无显著差异。
在接受剖宫产的产妇中预防性使用 TXA 可显著减少出血量，且不会增加不良反应，支持其作为减少该人群 PPH 的安全有效的策略。
PROSPERO（CRD42023422188）；首次提交日期为 2023 年 4 月 27 日。
