Tranexamic acid is a common antifibrinolytic drug used to prevent blood loss during surgeries and treat heavy menstrual cycles. Several small studies suggest that tranexamic acid may also help reduce blood loss after cesarean deliveries. In order to determine if tranexamic acid, in addition to the standard prophylactic uterotonic drug, would help reduce postpartum hemorrhage (i.e., blood loss >1000 mL or RBC transfusion within 2 days postpartum) after cesarean deliveries, researchers in France enrolled 4551 women planning cesarean deliveries in a double-blind, multicenter trial. Women were randomized in a 1:1 ratio to receive tranexamic acid or placebo (saline) minutes after birth and were followed for three months for adverse reactions. Of the 4153 women who underwent cesarean deliveries, 26.7% (556/2086) in the tranexamic acid arm experienced postpartum hemorrhage compared to 31.7% (653/2067) in the placebo arm (adjusted RR, 0.84; 95% C.I., 0.75-0.94; P=0.003), but there were no significant differences in the estimated amount of blood lost or the use of additional uterotonic drugs. Furthermore, no significant differences in blood transfusions were observed. Thromboembolic events occurred at similar rates in both groups enrolled in this trial, but recent studies of tranexamic acid use in patients with gastrointestinal bleeding have found higher rates. Tranexamic acid reduces blood loss after cesarean delivery, but additional studies are needed to ensure safety.
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