title: Tranexamic acid for the prevention and treatment of postpartum haemorrhage.
abstract: Postpartum haemorrhage (PPH) is a major cause of maternal mortality, accounting for one-quarter of all maternal deaths worldwide. Uterotonics after birth are the only intervention that has been shown to be effective for PPH prevention. Tranexamic acid (TXA), an antifibrinolytic agent, has therefore been investigated as a potentially useful complement to this for both prevention and treatment because its hypothesized mechanism of action in PPH supplements that of uterotonics and because it has been proved to reduce blood loss in elective surgery, bleeding in trauma patients, and menstrual blood loss. This review covers evidence from randomized controlled trials (RCTs) for PPH prevention after caesarean (n=10) and vaginal (n=2) deliveries and for PPH treatment after vaginal delivery (n=1). It discusses its efficacy and side effects overall and in relation to the various doses studied for both indications. TXA appears to be a promising drug for the prevention and treatment of PPH after both vaginal and caesarean delivery. Nevertheless, the current level of evidence supporting its efficacy is insufficient, as are the data about its benefit:harm ratio. Large, adequately powered multicentre RCTs are required before its widespread use for preventing and treating PPH can be recommended.
authors.affiliation: Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France loicsentilhes@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: Department of Anesthesiology, Angers University Hospital, Angers, France.
authors.forename: S
authors.initials: S
authors.lastname: Lasocki
authors.affiliation: Department of Anesthesiology, Jeanne de Flandre University Hospital, Lille, France.
authors.forename: A S
authors.initials: AS
authors.lastname: Ducloy-Bouthors
authors.affiliation: Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Deruelle
authors.affiliation: Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France.
authors.forename: M
authors.initials: M
authors.lastname: Dreyfus
authors.affiliation: Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Perrotin
authors.affiliation: Port-Royal Maternity Unit, Department of Obstetrics and Gynecology, Cochin University Hospital, APHP, Paris, France INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Goffinet
authors.affiliation: INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Deneux-Tharaux
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D002585:Cesarean Section; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: caesarean and vaginal deliveries; postpartum haemorrhage; prevention; tranexamic acid; treatment