Effects of tranexamic acid on the amount of bleeding following vaginal delivery and its adverse effects: a double-blind placebo controlled randomized clinical trial.

Abstract

INTRODUCTION\nPostpartum hemorrhage (PPH) is the most important concern after delivery. Tranexamic acid (TXA), an anti-fibrinolytic agent, has been suggested for prevention and treatment of PPH.\n\n\nOBJECTIVE\nThe purpose of the present study was to find the effects of TXA on the amount of bleeding following vaginal delivery and its adverse effects.\n\n\nMATERIALS AND METHODS\nThe study was performed as a randomized double blind placebo controlled clinical trial on low risk pregnant women who delivered vaginally. The patients were randomly assigned into two groups. Women in the intervention group received 10\u2009mg/kg infusion of TXA in 100\u2009mL normal saline and the control group received one vial of distilled water (as placebo) in 100\u2009mL normal saline. The primary outcome was amount of bleeding after delivery. The secondary outcomes were decreased in hemoglobin level, need for additional uterotonic agents and need for blood transfusion. All were evaluated 6\u2009h after delivery and compared in the two groups. Participants were followed up to six weeks after delivery for any TXA side effects.\n\n\nRESULTS\nTwo hundred and seven women finished the study. There were no significant differences between the two groups in terms of demographic data and risk factors for bleeding. Mean blood loss and need to misoprostol was more in the control group (p=.033 and p=.000, respectively). Hemoglobin level was higher in the TXA group 6\u2009h after delivery. None of the subjects needed blood transfusion, uterine balloon tamponade or emergency hysterectomy. Adverse effects were higher in the TXA group, however, there were no side effects between weeks 3 and 6 in both groups. There were no thromboembolic events during six weeks after delivery.\n\n\nCONCLUSIONS\nTranexamic acid can reduce the amount of bleeding after vaginal delivery in low risk women without having serious complications. Also, it may decrease the need for additional uterotonic agents. Trial registration number and registry website: IRCT20091023002624N22.