Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20173456Keywords:
Anaemia, Blood transfusion, Caesarean section, Tranexamic acidAbstract
Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.
Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.
Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.
Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS.
References
NFHS-4. 2015-16. Factsheet: Available at www.rchiips.org/nfhs.
Healy TEJ, Knight PR. Obstetric Anaesthesia. Wilie and Churchill Davidson’s A Practice of Anaesthesia. 7th edition. Churchill-Davidson; 2003:934.
Ramani B, Nayak L. Intravenous 1gram tranexamic acid for prevention of blood loss and blood transfusion during caesarean section: a randomised case control study. Int J Reprod Contracept Obstet Gynecol. 2014;3:366-9.
Wang HY, Hong SK, Duan Y, Yin HM. Tranexamic acid and blood loss during and after caesarean section: a meta-analysis. J Perinatol. 2015;35(10):818-25.
Goswami U, Sarangi S, Gupta S, Babbar S. Comparative evaluation of two doses of tranexamic acid used prophylactically in anemic parturients for lower segment caesarean section: A double-blind randomised case control prospective trial. Saudi J Anaesth. 2013;7:427-31.
Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015;(6):CD007872.
Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009;91(6):776-83.
Neilipovitz DT. Tranexamic acid for major spinal surgery. Eur Spine J. 2004;13(Suppl 1):S62-5.
Benoni G. Tranexamic acid reduces the blood loss in knee arthroplasty- if it’s administered at the right time. Lakartidningen. 1999;96(24):2967-9.
Cheuk BL, Cheung GC, Cheng SW. Epidemiology of venous thromboembolism in a Chinese population. Br J Surg. 2004;91:424-8.
