دورية أكاديمية
Prophylactic Tranexamic Acid Prevents Postpartum Hemorrhage and Transfusions in Cesarean Deliveries: A Systematic Review and Meta-analysis.
| العنوان: | Prophylactic Tranexamic Acid Prevents Postpartum Hemorrhage and Transfusions in Cesarean Deliveries: A Systematic Review and Meta-analysis. |
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| المؤلفون: | Lee A; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Wang MY; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Roy D; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Wang J; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Gokhale A; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Miranda-Cacdac L; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Kuntz M; A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona., Grover B; Department of Obstetrics and Gynecology, Banner University Medical Center Phoenix, Phoenix, Arizona., Gray K; Department of Obstetrics and Gynecology, Banner University Medical Center Phoenix, Phoenix, Arizona., Curley KL; Department of Obstetrics and Gynecology, Banner University Medical Center Phoenix, Phoenix, Arizona. |
| المصدر: | American journal of perinatology [Am J Perinatol] 2024 May; Vol. 41 (S 01), pp. e2254-e2268. Date of Electronic Publication: 2023 Jun 13. |
| نوع المنشور: | Journal Article; Systematic Review; Meta-Analysis |
| اللغة: | English |
| بيانات الدورية: | Publisher: Thieme-Stratton Country of Publication: United States NLM ID: 8405212 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-8785 (Electronic) Linking ISSN: 07351631 NLM ISO Abbreviation: Am J Perinatol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Thieme-Stratton, 1983- |
| مواضيع طبية MeSH: | Postpartum Hemorrhage*/prevention & control , Tranexamic Acid*/therapeutic use , Tranexamic Acid*/administration & dosage , Cesarean Section*/adverse effects , Blood Transfusion*/statistics & numerical data , Antifibrinolytic Agents*/therapeutic use , Antifibrinolytic Agents*/administration & dosage, Humans ; Female ; Pregnancy ; Randomized Controlled Trials as Topic ; Blood Loss, Surgical/prevention & control |
| مستخلص: | Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and PPH resulting in transfusion is the most common maternal morbidity in the United States. Literature demonstrates that tranexamic acid (TXA) can reduce blood loss in cesarean deliveries; however, there is little consensus on the impact on major morbidities like PPH and transfusions. We conducted a systematic review/meta-analysis of randomized controlled trials (RCTs) to evaluate if administration of prophylactic intravenous (IV) TXA prevents PPH and/or transfusions following low-risk cesarean delivery. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. Five databases were searched: Cochrane, EBSCO, Ovid, PubMed, and ClinicalKey. RCTs published in English between January 2000 and December 2021 were included. Studies compared PPH and transfusions in cesarean deliveries between prophylactic IV TXA and control (placebo or no placebo). The primary outcome was PPH, and the secondary outcome was transfusions. Random effects models were used to calculate effect size (ES) of exposure in Mantel-Haenszel risk ratios (RR). All analysis was done at a confidence level (CI) of α = 0.5. Modeling showed that TXA led to significantly less risk of PPH than control (RR: 0.43; 95% CI: 0.28-0.67). The effect on transfusion was comparable (RR: 0.39; 95% CI: 0.21-0.73). Heterogeneity was minimal ( I 2 = 0%). Due to the large sample sizes needed, many RCTs are not powered to interpret TXA's effect on PPH and transfusions. Pooling these studies in a meta-analysis allows for more power and analysis but is limited by the heterogeneity of studies. Our results minimize heterogeneity while demonstrating that prophylactic TXA can lower PPH occurrence and reduce the need for blood transfusion. We suggest considering prophylactic IV TXA as the standard of care in low-risk cesarean deliveries. KEY POINTS: · Consider TXA prior to incision for singleton, term pregnancies undergoing elective cesarean.. · Prophylactic TXA is effective in preventing PPH and blood transfusions.. · Routine use of TXA has the potential to decrease transfusion-related complications and costs.. Competing Interests: None declared. (Thieme. All rights reserved.) |
| المشرفين على المادة: | 6T84R30KC1 (Tranexamic Acid) 0 (Antifibrinolytic Agents) |
| تواريخ الأحداث: | Date Created: 20230613 Date Completed: 20240530 Latest Revision: 20240730 |
| رمز التحديث: | 20240730 |
| DOI: | 10.1055/a-2109-3730 |
| PMID: | 37311543 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1098-8785 |
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| DOI: | 10.1055/a-2109-3730 |