Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

Pravin Shah; Ajay Agrawal; Shailaja Chhetri; Pappu Rijal; Nisha K. Bhatta

doi:10.18203/2320-1770.ijrcog20190017

Authors

Pravin Shah Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
Ajay Agrawal Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
Shailaja Chhetri Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
Pappu Rijal Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
Nisha K. Bhatta Department of Pediatrics and Adolescent Medicine, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190017

Keywords:

Cesarean section, Postpartum hemorrhage, Tranexamic acid

Abstract

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.

Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.

Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).

Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

Metrics

Metrics Loading ...

References

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van LPF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113.

Levy JH, Dutton RP, Hemphill JC, Shander A, Cooper D, Paidas MJ, et al. Multidisciplinary approach to the challenge of hemostasis. Anesth Analg. 2010;110(2):354-64.

Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, McClelland B, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007;(4):CD001886.

Katsaros D, Petricevic M, Snow NJ, Woodhall DD, Van Bergen R. Tranexamic acid reduces postbypass blood use: a double-blinded, prospective, randomized study of 210 patients. Ann Thorac Surg. 1996;61(4):1131-5.

Williams-Johnson JA, McDonald AH, Strachan GG, Williams EW. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) A randomised, placebo-controlled trial. West Indian Med J. 2010;59(6):612-24.

Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk OC, Sudolmus S, Ark C. Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol. 2011;28(212):233-40.

Ferrer P, Roberts I, Sydenham E, Blackhall K, Shakur H. Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC Preg Childbirth. 2009;9:29.

Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57(6):1005-32.

Neilipovitz DT. Tranexamic acid for major spinal surgery. Eur Spine J. 2004;13(Suppl 1):S62-5.

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.

Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005;76(3):314-9.

Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199(5):519.e1-7.

Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. Int J Gynecol Obstet. 2011;115(3):224-6.

Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: A multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol. 2004;112:154-7.

Shahid A, Khan A. Tranexamic acid in decreasing blood loss during and after caesarean section. J Coll Physicians Surg Pakistan. 2013;23(7):459-62.

Yehia AH, Koleib MH, Abdelazim IA, Atik A. Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial. Asian Pac J Reprod. 2014;3(1):53-6.

Abdel-Aleem H, Alhusaini TK, Abdel-Aleem MA, Menoufy M, Gülmezoglu AM. Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. J Matern Fetal Neonatal Med. 2013;26(17):1705-9.

Lindoff C, Rybo G, Astedt B. Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications. Thromb Haemost. 1993;70(2):238-40.