Efficacy of Intravenous Tranexamic Acid at Reducing Blood Loss During Caesarean Section in A Parturient at Increased Risk of Primary Postpartum Hemorrhage: A Randomized Placebo Controlled Trial
Abstract:
Background: Caesarean section is the most frequently performed surgery worldwide and is a source of concern to obstetricians due to the attendant increased health risk. Its most common complication is increased risk of bleeding which occasionally may be life threatening. Tranexamic acid (TXA), an anti-fibrinolytic agent, has recently been investigated as a potentially useful drug for both prevention and treatment of excessive blood loss at caesarean section and its advantages need evaluation in our environment.
Objective: This study was designed to evaluate the efficacy of tranexamic acid at reducing the quantity of blood loss in women at increased risk of primary postpartum haemorrhage (PPH) undergoing caesarean section.
Method: This was a double-blind randomized placebo-controlled trial on the efficacy and safety of intravenous tranexamic acid at reducing blood loss in women at increased risk for PPH undergoing caesarean section at the Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA). Data analysis was done using statistical Package for Social Science (IBM SPSS) software (version 20, Chicago II, USA). Continuous variables were presented as mean and standard deviation (Mean ± 2SD), while categorical variables were presented as numbers and percentages. A difference with a P value 1000mls was also significantly lower in the study group compared with the control group with 9(10.9%) versus 19(22.9%) respectively; Odd Ratio (OR) 0.42; 95% Confidence interval (CI) 0.17 to 0.98; p=0.0414.
Results:The mean change in haematocrit value was significantly less in the tranexamic acid group compared with the control group p=0.0012. Tranexamic acid significantly reduced the need for additional uterotonics 13(15.8%) versus 27(32.5%) OR 0.39 (0.18 – 0.82) p value equals 0.0122. However, there was no difference in the number of patients that had blood transfusion between the groups and the maternal side effect profiles were similar.
Conclusion: Intravenous tranexamic acid significantly reduced blood loss in women at increased risk of bleeding during caesarean section. It also reduced the risk of blood loss greater than 1000mls and the need for additional uterotonics without increasing maternal risks.
