Tranexamic acid reduces life-threatening postpartum bleeding

1. Tranexamic acid significantly reduced life-threatening postpartum bleeding.

2. There were no differences in the risk of thromboembolic events.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Postpartum hemorrhage is a significant cause of maternal mortality. While tranexamic acid is used to treat this condition, its potential to prevent bleeding remains unclear. This systematic review and meta-analysis aimed to examine tranexamic acid’s effects in reducing life-threatening bleeding and thromboembolic risk in women giving birth. The primary outcome of this study was the number of women with life-threatening bleeding, while a key secondary outcome was the incidence of thromboembolic events. According to study results, tranexamic acid significantly lowered the risk of life-threatening bleeding compared to placebo. Although this study was well done, it was limited by its focus on a specific subset of large, low-bias trials, which may not fully represent outcomes in broader populations.

Click to read the study in The Lancet

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In-depth [systematic review and meta-analysis]: Randomized trials assessing the effects of tranexamic acid in women giving birth were assessed from databased inception to Aug 4, 2024. Included were those that were prospectively registered, placebo-controlled, involving > 500 patients, and having low bias risk. Altogether, 54 404 women were included in the final analysis. The primary outcome showed that tranexamic acid significantly reduced the rate of life-threatening postpartum bleeding compared to placebo (178 vs. 230, odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.93, p=0.008). The secondary outcome of thromboembolic events found no significant difference between groups (50 vs. 52, OR 0.96, 95% CI 0.65-1.41, p=0.82). Findings from this study suggest that tranexamic acid is effective in preventing severe bleeding in childbirth without increasing thromboembolic risks.

Image: PD

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