title: [Efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of post-partum haemorrhage: a systematic review with meta-analysis].
abstract: OBJECTIVE
  Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.
  
  
  METHODS
  Systematic review with meta-analysis.
  
  
  METHODS
  Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.
  
  
  RESULTS
  Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.
  
  
  CONCLUSIONS
  Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.
authors.affiliation: Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique. Electronic address: davidfaraoni@icloud.com.
authors.forename: D
authors.initials: D
authors.lastname: Faraoni
authors.affiliation: Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique.
authors.forename: C
authors.initials: C
authors.lastname: Carlier
authors.affiliation: Service d'anesthésie-réanimation, CHU Cochin, Assistance-publique-Hôpitaux de Paris, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
authors.forename: C M
authors.initials: CM
authors.lastname: Samama
authors.affiliation: Service d'anesthésie-réanimation, Duke University School of Medicine, Durham, 27710 Caroline du Nord, États-Unis.
authors.forename: J H
authors.initials: JH
authors.lastname: Levy
authors.affiliation: Service d'anesthésie-réanimation, CHRU de Lille Jeanne-de-Flandre, avenue Oscar-Lambret, 59037 Lille, France.
authors.forename: A S
authors.initials: AS
authors.lastname: Ducloy-Bouthors
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Acide tranexamique; Blood-sparing technique; Caesarean section; Coagulopathie; Coagulopathy; Césarienne; Hémorragie du post-partum; Obstetrics; Obstétrique; Post-partum haemorrhage; Tranexamic acid; Épargne sanguine