title: Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery.
abstract: OBJECTIVE
  To assess the effects of tranexamic acid among patients undergoing cesarean delivery who were at high risk of postpartum hemorrhage.
  
  
  METHODS
  Between August 1, 2012, and April 30, 2013, a randomized controlled trial was performed at a tertiary care center in India. Women undergoing an elective or emergency cesarean delivery who were at high risk for postpartum hemorrhage were enrolled. They were randomly assigned using sealed, opaque envelopes to receive 10mg/kg tranexamic acid or normal saline 10min before skin incision. Anesthesiologists were not masked to group assignment, but patients and obstetricians were. The primary outcome was need for additional uterotonic drugs within 24h after delivery. Analyses were by intention to treat.
  
  
  RESULTS
  Thirty patients were assigned to each group. Additional uterotonic drugs were required in 7 (23%) patients assigned to tranexamic acid and 25 (83%) patients in the control group (P<0.001).
  
  
  CONCLUSIONS
  Intravenous tranexamic acid, administered before skin incision, significantly reduced the requirement for additional uterotonics among women at increased risk for postpartum hemorrhage. Clinical Trials Registry India: CTRI/2015/05/005752.
authors.affiliation: Department of Anaesthesia, Max Hospital, Saket, New Delhi, India. Electronic address: drnambiath@yahoo.com.
authors.forename: Nambiath
authors.initials: N
authors.lastname: Sujata
authors.affiliation: Department of Anaesthesia, Max Hospital, Saket, New Delhi, India.
authors.forename: Raj
authors.initials: R
authors.lastname: Tobin
authors.affiliation: Department of Anaesthesia, Max Hospital, Saket, New Delhi, India.
authors.forename: Ranjeet
authors.initials: R
authors.lastname: Kaur
authors.affiliation: Department of Obstetrics and Gynecology, Fortis Hospitals, New Delhi, India.
authors.forename: Anjila
authors.initials: A
authors.lastname: Aneja
authors.affiliation: Department of Anaesthesia, Max Hospital, Saket, New Delhi, India.
authors.forename: Mona
authors.initials: M
authors.lastname: Khanna
authors.affiliation: Department of Anaesthesia, Max Hospital, Saket, New Delhi, India.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Hanjoora
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007194:India; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Cesarean delivery; High-risk pregnancy; Postpartum hemorrhage; Tranexamic acid