title: Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum.
abstract: OBJECTIVE
  The aim of this study is critically to review the available evidence regarding the use, efficacy and safety of tranexamic acid in the management of hemorrhage during pregnancy and for prevention and treatment of postpartum hemorrhage.
  
  
  METHODS
  We performed a systematic search of electronic literature (PubMed, Embase, CINAHL, Scopus, Cochrane, DARE) to review all studies looking at the use of tranexamic acid during pregnancy and puerperium. We did a meta-analysis on three randomized controlled trials that evaluated reduction in blood loss in women undergoing cesarean sections with the use of tranexamic acid.
  
  
  RESULTS
  An electronic search yielded 34 articles, the studies dating from 1976 to 2010, five randomized controlled trials, seven observational studies, and twenty-two case reports. Meta-analysis showed that the estimate of the combined effect of tranexamic acid compared with placebo was a difference of 32.5 ml reduction in blood loss (95% CI -4.1-69.13; p = 0.08). Tranexamic acid was also used successfully to prevent and treat bleeding in observation studies and case reports. Pulmonary embolism was reported in two cases; however, the possible involvement of tranexamic acid in these thrombotic episodes could neither be confirmed nor excluded.
  
  
  CONCLUSIONS
  The clinical studies suggest that tranexamic acid reduces the amount of blood loss after delivery during cesarean sections and vaginal deliveries, and reduces the requirement for blood transfusion. Tranexamic acid seems to be safe and effective in the prevention and management of bleeding during pregnancy. Further investigation and larger clinical trials with better design and methodological quality are required to confirm these findings.
authors.affiliation: The Royal Free Hospital, Haemophilia Centre & Thrombosis Unit, Department of Obstetrics and Gynaecology, Pond Street, London, UK. panagiotis_pp@yahoo.com
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Peitsidis
authors.forename: Rezan A
authors.initials: RA
authors.lastname: Kadir
mesh_terms: D000818:Animals; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002986:Clinical Trials as Topic / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid