Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials
Análise da eficácia do ácido tranexâmico profilático na prevenção do sangramento pós-parto: revisão sistemática com metanálise de ensaios clínicos randomizados
Ivo de C. Assis, Catia S. Govêia, Denismar B. Miranda, Rafael S. Ferreira, Luiza G.C. Riccio
Abstract
Background
Postpartum Hemorrhage (PPH) is one of the main causes of maternal mortality, mainly in the poorest regions of the world, drawing attention to the need for strategies for preventing it. This study aims to evaluate the efficacy of prophylactic administration of Tranexamic Acid (TXA) in decreasing blood loss in pregnant women in delivery, preventing PPH.
Methods
Systematic review of randomized clinical trials. We searched for publications in PubMed, EMBASE and Cochrane Library databases, with the uniterms “postpartum, puerperal hemorrhage” and “tranexamic acid”, published between January of 2004 and January of 2020. The eligibility criteria were trials published in English with pregnant women assessed during and after vaginal or cesarean delivery about the effect of prophylactic use of TXA on bleeding volume. The random-effects model was applied with the DerSimonian-Laird test and the Mean Difference (MD) was calculated for continuous variables together with each 95% CI. This systematic review was previously registered in the PROSPERO platform under the registration n° CRD42020187393.
Results
Of the 630 results, 16 trials were selected, including one with two different doses, performing a total of 6731 patients. The intervention group received a TXA dose that varied between 10 mg.kg−1 and 1g (no weight calculation). The TXA use was considered a protective factor for bleeding (MD: -131.07; 95% CI: -170.00 to -92.78; p = 0.000) and hemoglobin variation (MD: -0.417; 95% CI: -0.633 to -0.202; p = 0.000). In the subgroup analysis related to the cesarean pathway, the effect of TXA was even greater.
Conclusion
The prophylactic use of tranexamic acid is effective in reducing the post-partum bleeding volume.
PROSPERO registration ID
CRD42020187393.
Keywords
Resumo
Introdução
A Hemorragia Pós-Parto (HPP) é uma das principais causas de mortalidade materna, principalmente nas regiões mais pobres do mundo, chamando a atenção para a necessidade de estratégias para preveni-la. Este estudo tem como objetivo avaliar a eficácia da administração profilática de Ácido Tranexâmico (TXA) na diminuição da perda sanguínea em gestantes no parto, prevenindo a HPP.
Métodos
Revisão sistemática de ensaios clínicos randomizados. Buscamos publicações nas bases de dados PubMed, EMBASE e Cochrane Library, com os unitermos “postpartum, puerperal hemorrhage” e “tranexamic acid”, publicadas entre janeiro de 2004 e janeiro de 2020. Os critérios de elegibilidade foram ensaios publicados em inglês com gestantes avaliadas durante e após parto vaginal ou cesariana sobre o efeito do uso profilático de TXA no volume de sangramento. O modelo de efeitos aleatórios foi aplicado com o teste DerSimonian-Laird e a Diferença Média (MD) foi calculada para variáveis contínuas juntamente com cada IC 95%. Esta revisão sistemática foi previamente registrada na plataforma PROSPERO sob o registro n° CRD42020187393.
Resultados
Dos 630 resultados, foram selecionados 16 ensaios, incluindo um com duas doses diferentes, realizando um total de 6.731 pacientes. O grupo intervenção recebeu uma dose de TXA que variou entre 10 mg.kg−1 e 1g (sem cálculo de peso). O uso de TXA foi considerado fator protetor para sangramento (DM: -131,07; IC 95%: -170,00 a -92,78; p = 0,000) e variação da hemoglobina (DM: -0,417; IC 95%: -0,633 a -0,202; p = 0,000). Na análise de subgrupo relacionada à via cesariana, o efeito do TXA foi ainda maior.
Conclusão
O uso profilático de ácido tranexâmico é eficaz na redução do volume de sangramento pós-parto.
ID de registro PROSPERO
CRD42020187393.
Palavras-chave
References
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