Prophylactic tranexamic acid for reducing blood loss in pregnant females undergoing cesarean section: A systematic review and meta-analysis.

Objective: We aim to assess the efficacy of prophylactic tranexamic acid (TXA) in reducing blood loss after cesarean section (CS).

Methods: We systematically searched PubMed and Embase for randomized controlled trials published between 1990 and 2023 to conduct a meta-analysis on adult women undergoing CS and receiving prophylactic TXA.

Results: Twenty-four trials, comprising 19 584 participants, were included. Most studies included women with healthy, full-term, singleton pregnancies. The pooled estimate showed a reduction in mean blood loss in the TXA arm with a standardized mean difference (SMD) of -1.50 (-2.03, -0.98: p < 0.001). There was a high level of heterogeneity (I 98.86%). A subgroup analysis demonstrated no statistical difference in the effect of TXA on blood loss at 2 h of follow-up with SMD of -2.24 (-3.23, -1.35) compared to -1.07 (-1.56, -0.58) and -1.10 (-2.62, -0.42) at 24 and 48 h, respectively (p = 0.11). The effect of TXA on blood loss was smaller in high-income countries with SMD -0.24 (-0.44, -0.04) (I 63%) than in low-/middle-income countries -1.78 (-2.35, -1.21) with I 98%. Only three studies had low risk of bias and the effect of TXA from two of them was SMD -0.31 (-0.54, -0.09) (I 0%).

Conclusions: Despite the apparent beneficial effect of TXA in reducing blood loss after CS for women with uncomplicated term pregnancies, heterogeneity remains a serious concern. The current body of knowledge consists predominantly of small, likely biased studies, and large unbiased studies show only limited effects of prophylactic TXA.