Guinness Frederick, Hanley Ciara, Spring Aidan
Department of Anaesthesia, St James Hospital, Dublin, Ireland.
Department of Anaesthesia, University Hospital Galway, Galway, Ireland.
Ir J Med Sci. 2025 Feb;194(1):311-322. doi: 10.1007/s11845-024-03834-y. Epub 2024 Dec 9.
The 2022 national guideline on The Prevention and Management of Primary Postpartum Haemorrhage (PPH) recommended consideration of prophylactic tranexamic acid (TXA) for women who are at high PPH risk undergoing caesarean section (CS). This meta-analysis reviews the basis for this recommendation.
PubMed, OVID Medline, EMBASE, Science Citation Index, Scopus, CENTRAL, and ClinicalTrials.gov were searched (from inception to January 2024) for randomised controlled trials comparing prophylactic intravenous TXA with placebo or no treatment in women undergoing CS who received a uterotonic. Our main outcome was PPH > 1L. Secondary outcomes included estimated mean blood loss, blood transfusion, drop in haemoglobin, the need for additional uterotonics, or surgical intervention. Adverse effects of TXA were also assessed.
Sixty-one studies including 25,098 women were identified, and 12,446 received prophylactic TXA. Patients who received prophylactic TXA had significantly reduced likelihood of PPH > 1L (RR, 0.47; 95% CI, 0.38 to 0.59), reduced estimated mean blood loss (MD 185.86 ml, 95% CI 159.14-212.59), and reduced drop in Hb (MD 0.84g/dl, 95% CI 0.72, 0.95). There was a significant reduction in need for additional uterotonics (RR 0.47, 95% CI 0.39-0.57) or surgical intervention (RR 0.54, 95% CI 0.30-0.95).
The reduced risk of PPH > 1L was greatest in patients at higher risk of bleeding. The greatest risk reduction was seen in smaller studies and in studies undertaken in developing economies. Prophylactic TXA administration is effective at reducing the incidence of PPH > 1L at CS. The clinical benefit of universal prophylaxis is questionable; women who are high risk of PPH are more likely to derive benefit.
2022年《原发性产后出血的预防与管理国家指南》建议，对于剖宫产（CS）时产后出血风险较高的女性，考虑使用预防性氨甲环酸（TXA）。本荟萃分析回顾了这一建议的依据。
检索了PubMed、OVID Medline、EMBASE、科学引文索引、Scopus、CENTRAL和ClinicalTrials.gov（从创刊至2024年1月），以查找在接受宫缩剂的剖宫产女性中，比较预防性静脉注射TXA与安慰剂或不治疗的随机对照试验。我们的主要结局是产后出血>1L。次要结局包括估计平均失血量、输血、血红蛋白下降、是否需要额外使用宫缩剂或进行手术干预。还评估了TXA的不良反应。
共纳入61项研究，涉及25,098名女性，其中12,446名接受了预防性TXA。接受预防性TXA的患者产后出血>1L的可能性显著降低（RR，0.47；95%CI，0.38至0.59），估计平均失血量减少（MD 185.86 ml，95%CI 159.14 - 212.59），血红蛋白下降幅度减小（MD 0.84g/dl，95%CI 0.72，0.95）。额外使用宫缩剂（RR 0.47，95%CI 0.39 - 0.57）或手术干预（RR 0.54，95%CI 0.30 - 0.95）的需求也显著降低。
产后出血>1L风险降低幅度在出血风险较高的患者中最大。在规模较小的研究以及发展中经济体进行的研究中，风险降低幅度最大。预防性使用TXA可有效降低剖宫产时产后出血>1L的发生率。普遍预防的临床益处值得怀疑；产后出血风险高的女性更可能从中获益。
