Efficacy of tranexamic acid in decreasing blood loss during cesarean section

Introduction

Despite significant progress in obstetric care, the problem of bleeding during labor remains unsolved. Annually in the world, 125,000 women die from obstetric hemorrhage.

Methods

We performed a randomized, double-blind study in 37 patients who underwent cesarean section. Patients were divided into two groups: the first group (n = 19) received preoperative (30 minutes before operation) tranexamic acid 10 mg/kg; the second group (n = 18) received preoperative placebo. The condition of hemostasis was monitored by haemoviscoelastography.

Results

All patients included in the study before surgery had moderate hypercoagulation and normal fibrinolysis: increasing the intensity of clot formation (ICF) to 11.4% compared with normal rates; the intensity of the retraction and clot lysis (IRCL) was 16.45 ± 1.40 in both groups. At the start of the operation in patients (Group 1), ICF decreased by 9.7% (P < 0.05), and IRCL decreased by 27.6% (P < 0.05) compared with preoperatively. In Group 2, there was ICF decrease by 8.8% (P < 0.05), and IRCL increase by 11.4% (P < 0.05) compared with preoperatively. At the end of the operation, the condition of hemostasis in both groups came almost to the same value - moderate hypocoagulation, depressed fibrinolysis. In both groups there were no thrombotic complications. Intraoperative blood loss in the first group was 300 ± 40.5 and in the second was 500 ± 60.6.

Conclusion

Using of tranexamic acid before surgery significantly reduces intraoperative blood loss by 60%, without thrombotic complications.