Tranexamic acid does not prevent haemorrhage-related events in Caesarean section

Among women with multiple pregnancies, prophylactic treatment with tranexamic acid does not appear to reduce the incidence of blood loss-related events following caesarean delivery, a study has shown.

Researchers performed a secondary analysis of the TRAAP2 trial, which involved 4,551 women with multiple pregnancies. Those who were scheduled to undergo caesarean delivery were randomized to receive 1 g of tranexamic acid (n=160) or placebo (n=159) intravenously, both with prophylactic uterotonics, before or during labour at ≥34 gestational weeks.

The primary outcome was a calculated estimated blood loss >1,000 mL or a red blood cell transfusion at 2 days after delivery. Secondary outcomes were clinical and laboratory blood loss measurements. A total of 319 women had multiple pregnancy and caesarean delivery, with primary outcome data available in 298 (93.4 percent).

Blood loss >1,000 mL or a red blood cell transfusion at 2 days after delivery occurred in 62 out of 147 women (42.2 percent) in the tranexamic acid group and 67 out of 152 (44.1 percent) in the placebo group. The difference did not reach statistical significance, and the corresponding adjusted risk ratio was 0.97 (95 percent confidence interval, 0.68–1.38; p=0.86).

Likewise, there was no significant between-group differences seen in any of the following blood loss-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant haemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>0.05 for all comparisons).

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

The findings show that tranexamic acid does not prevent blood loss in caesarean delivery among women with multiple pregnancies.