Efficacy of Preoperative Tranexamic Acid Administration for Intraoperative Blood Loss Reduction in High-risk Cesarean Delivery: A randomized controlled trial
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Abstract
Objectives: To evaluate the efficacy of preoperative tranexamic acid (TXA) in reducing intraoperative blood loss in high-risk cesarean deliveries.
Materials and Methods: A randomized controlled trial was conducted with 50 pregnant women with gestational age over 34 weeks and a high risk of postpartum hemorrhage (PPH) (e.g., previous cesarean delivery, fetal macrosomia, and placenta previa) who underwent cesarean delivery using spinal anesthesia. The intervention group received one gram of TXA intravenously before skin incision, and 0.9% sodium chloride solution was used in the placebo group. The primary outcome was the measurement of intraoperative blood loss.
Results: The TXA group showed significantly lower intraoperative blood loss when compared to the placebo group (495.8 ± 294.6 ml vs 925.6 ± 448.9 ml, mean difference: -429.8 ml, 95% confidence interval (CI): -645.8 to -213.9, p < 0.001). The incidence of blood loss > 1,000 ml was also significantly lower in the TXA group (8% vs 36%, relative risk = 0.22, 95% CI: 0.05 to 0.92, p = 0.039), and fewer significantly decreased hemoglobin levels were observed in the TXA group in comparison with the placebo group (1.1 ± 7.0 g/dL vs 6.9 ± 9.6 g/dL, mean difference: -5.7 g/dL, 95% CI: -10.5 to -0.9, p = 0.020). There was no difference in the requirement for additional uterotonic drugs (8% vs 28%, p = 0.065). No serious adverse effects were observed in this study.
Conclusion: TXA effectively reduced intraoperative blood loss in women at high risk of PPH who underwent cesarean deliveries.
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