Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial

Our purpose in conducting this study was to determine the efficacy of tranexamic acid (TXA) in reducing blood loss in patients after cesarean section (CS). A randomized, double-blind, case-controlled study was conducted on 174 primipara undergoing CS. 88 of them given 10 mg/kg TXA immediately before CS were compared with 86 others to whom TXA was not given. Blood loss was calculated from blood collected and measured during two periods: the first period was from placental delivery to end of CS and the second from the end of CS to 2 h postpartum. Vital signs such as BP, HR, RP, hemoglobin, platelet count, postoperative PT and PPT were tested in the two groups. Blood loss in the period between the end of CS and 2 h postpartum was significantly lower (p < 0.01) in the TXA group (46.6 +/- A 42.7) than in the control group (84.7 +/- A 80.2). The quantity of total blood from placental delivery to 2 h postpartum was also significantly reduced (p = 0.02) in the TXA group (379.2 +/- A 160.1) than in the control group (441.7 +/- A 189.5). However, the amount of blood loss in the period from placental delivery to the end of CS did not differ between the TXA and control groups (p = 0.17). PPH stopped in 65 women (75.6 %) in the control group and in 81 (92.0 %) in the TXA group (p < 0.01). No significant abnormal vital signs were observed after TXA administration. Mild, transient side effects occurred more often in the TXA group than in the control group. Treatment with TXA is effective in reducing blood loss in patients undergoing CS. Although the study was not adequately powered to address safety issues, the observed side effects were mild and transient.