Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery

This multicenter, double blind, randomized controlled trial evaluated the efficacy of prophylactic tranexamic acid (1 g IV) versus placebo in reducing postpartum hemorrhage (PPH) among 4,431 women undergoing cesarean delivery at ≥34 weeks’ gestation. All participants received prophylactic uterotonic agents. The primary outcome calculated estimated blood loss >1000 mL or red-cell transfusion within 2 days occurred in 26.7% of the tranexamic acid group versus 31.6% of the placebo group (adjusted risk ratio, 0.84; 95% CI, 0.75–0.94; P=0.003). However, no significant differences were observed in secondary clinical outcomes (e.g., gravimetrically estimated blood loss, provider-assessed hemorrhage, or transfusion rates). Thromboembolic events were rare but numerically higher with tranexamic acid (0.4% vs. 0.1%; P=0.08). The study concluded that while tranexamic acid reduced calculated blood loss, it did not improve clinically significant hemorrhage outcomes. Funded by the French Ministry of Health (ClinicalTrials.gov: NCT03431805).

This multicenter, double blind, randomized controlled trial evaluated the efficacy of prophylactic tranexamic acid (1 g IV) versus placebo in reducing postpartum hemorrhage (PPH) among 4,431 women undergoing cesarean delivery at ≥34 weeks’ gestation. All participants received prophylactic uterotonic agents. The primary outcome calculated estimated blood loss >1000 mL or red-cell transfusion within 2 days occurred in 26.7% of the tranexamic acid group versus 31.6% of the placebo group (adjusted risk ratio, 0.84; 95% CI, 0.75–0.94; P=0.003). However, no significant differences were observed in secondary clinical outcomes (e.g., gravimetrically estimated blood loss, provider-assessed hemorrhage, or transfusion rates). Thromboembolic events were rare but numerically higher with tranexamic acid (0.4% vs. 0.1%; P=0.08). The study concluded that while tranexamic acid reduced calculated blood loss, it did not improve clinically significant hemorrhage outcomes. Funded by the French Ministry of Health (ClinicalTrials.gov: NCT03431805).