☆ 4.3 Review

Tranexamic acid versus misoprostol for management of postpartum hemorrhage: A systematic review and meta-analysis of randomized controlled trials

EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY (2023)

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Article Obstetrics & Gynecology

Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial

Mariam Dawoud et al.

Summary: This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin in reducing intra and post-operative blood loss in high-risk women undergoing cesarean section. The results showed that both tranexamic acid and misoprostol were equally effective in reducing blood loss, with significantly better outcomes compared to the control group. Estimated blood loss and reduction in hemoglobin and hematocrit were significantly lower in the tranexamic and misoprostol groups.

BMC PREGNANCY AND CHILDBIRTH (2023)

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Review Obstetrics & Gynecology

Prophylactic tranexamic acid among women undergoing vaginal delivery to reduce postpartum blood loss and related morbidities: A systematic review and meta-analysis of 17 randomized controlled trials

Ahmed Abu-Zaid et al.

Summary: The objective of this study was to systematically review and meta-analyze the efficacy and safety of prophylactic TXA in reducing postpartum blood loss and related morbidities in women undergoing vaginal delivery. The results showed that prophylactic TXA was associated with a significant decrease in postpartum blood loss and related complications, but it increased the risk of nausea, vomiting, and diarrhea. Overall, prophylactic TXA was found to be safe and should be integrated into the active management of the third stage of labor in vaginal delivery.

JOURNAL OF GYNECOLOGY OBSTETRICS AND HUMAN REPRODUCTION (2022)

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Review Anesthesiology

Tranexamic acid and obstetric hemorrhage: give empirically or selectively?

A. Shander et al.

Summary: TXA is a antifibrinolytic agent that has been used to reduce blood loss, particularly in managing postpartum hemorrhage after vaginal and cesarean deliveries. Current evidence suggests that TXA reduces mortality due to bleeding in developing countries, but the benefit-risk ratio in developed countries still needs further evaluation. The level of evidence is currently insufficient to recommend routine use of TXA for preventing blood loss after deliveries.

INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA (2021)

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Review Anesthesiology

Refractory uterine atony: still a problem after all these years

M. Balki et al.

Summary: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, with uterine atony being the primary cause of this complication. Oxytocin is the first-line drug for preventing and treating uterine atony, with other medications such as ergot alkaloids and prostaglandins being used as second-line agents. The choice of medication for second-line treatment should be based on the patient's adverse effect profile and comorbidities.

INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA (2021)

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Article Anesthesiology

Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery

Jean Wong et al.

Summary: Tranexamic acid is an effective and safe drug for managing clinically significant bleeding, with potential benefits particularly in trauma and obstetrical bleeding when administered early. However, limitations exist in the current evidence regarding dose, route, and timing variability, as well as generalizability to higher income nations.

CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE (2021)

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Review Medicine, General & Internal

Postpartum Hemorrhage

Jessica L. Bienstock et al.

Summary: Postpartum hemorrhage is mainly caused by uterine atony, lacerations, retained placenta or clots, and clotting factor deficiency. Treatment includes uterine massage, oxytocin, and methylergonovine, along with potential blood transfusion and cardiovascular support.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Review Surgery

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality A Systematic Review, Meta-analysis, and Meta-regression

Isabel Taeuber et al.

Summary: The systematic review and meta-analysis of 216 studies indicated that intravenous TXA, regardless of dosage, does not increase the risk of any thromboembolic events. These findings clarify the incidence of adverse events associated with intravenous TXA administration and suggest its safety for patients, particularly those receiving neurological care.

JAMA SURGERY (2021)

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Article Medicine, General & Internal

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J. Page et al.

SYSTEMATIC REVIEWS (2021)

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Review Hematology

The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients

Johnny Cai et al.

EUROPEAN JOURNAL OF HAEMATOLOGY (2020)

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Review Obstetrics & Gynecology

Comparison of the effects and side effects of misoprostol and oxytocin in the postpartum period: A systematic review

Zumrut Bilgin et al.

TAIWANESE JOURNAL OF OBSTETRICS & GYNECOLOGY (2019)

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Article Obstetrics & Gynecology

Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial

Hamideh Pakniat et al.

JOURNAL OF OBSTETRICS AND GYNECOLOGY OF INDIA (2019)

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Editorial Material Public, Environmental & Occupational Health

Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage

Joshua P. Vogel et al.

LANCET GLOBAL HEALTH (2018)

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Review Obstetrics & Gynecology

Active management of the third stage of labor: A brief overview of key issues

Kemal Gungorduk et al.

TURKISH JOURNAL OF OBSTETRICS AND GYNECOLOGY (2018)

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Article Medicine, General & Internal

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Julian P. T. Higgins et al.

BMJ-BRITISH MEDICAL JOURNAL (2011)

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Article Obstetrics & Gynecology

Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage

Dean Leduc et al.

JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA (2009)

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Editorial Material Medicine, General & Internal

GRADE:: an emerging consensus on rating quality of evidence and strength of recommendations

Gordon H. Guyatt et al.

BRITISH MEDICAL JOURNAL (2008)

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Article Medicine, General & Internal

Measuring inconsistency in meta-analyses

JPT Higgins et al.

BMJ-BRITISH MEDICAL JOURNAL (2003)

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Article Hematology

Hemostasis during normal pregnancy and puerperium

M Hellgren

SEMINARS IN THROMBOSIS AND HEMOSTASIS (2003)

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Article Obstetrics & Gynecology

Pharmacokinetics of different routes of administration of misoprostol

OS Tang et al.

HUMAN REPRODUCTION (2002)

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