Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial.

Abstract

BACKGROUND:

Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of >1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies.

OBJECTIVE:

This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies.

STUDY DESIGN:

This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of >1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements.

RESULTS:

Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>.05 for all comparisons).

CONCLUSION:

Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.

• Authors: Loïc Sentilhes, Hugo Madar, Maëla Le Lous, Marie Victoire Sénat, Norbert Winer, Patrick Rozenberg, Gilles Kayem, Eric Verspyck, Florent Fuchs, Elie Azria, Denis Gallot, Diane Korb, Raoul Desbrière, Camille Le Ray, Céline Chauleur, Fanny de Marcillac, Franck Perrotin, Olivier Parant, Laurent J Salomon, Emilie Gauchotte, Florence Bretelle, Nicolas Sananès, Caroline Bohec, Nicolas Mottet, Guillaume Legendre, Vincent Letouzey, Bassam Haddad, Delphine Vardon, Aurélien Mattuizzi, Alizée Froeliger, Hanane Bouchghoul, Valérie Daniel, Sophie Regueme, Caroline Roussillon, Aurore Georget, Astrid Darsonval, Antoine Benard, Catherine Deneux-Tharaux, Groupe de Recherche en Obstétrique et Gynécologie
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 227 Issue 6 Pg. 889.e1-889.e17 (12 2022) ISSN: 1097-6868 [Electronic] United States
• PMID: 35724759 (Publication Type: Randomized Controlled Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Tranexamic Acid
• Antifibrinolytic Agents

Topics

• Female
• Pregnancy
• Humans
• Tranexamic Acid (therapeutic use)
• Postpartum Hemorrhage (epidemiology)
• Antifibrinolytic Agents (therapeutic use)
• Cesarean Section (adverse effects)
• Blood Transfusion