Meta-Analysis Of The Efficacy Of Tranexamic Acid In Preventing Hemorrhage During And After Selective Cesarean Section

Objective:To systematically evaluate the efficacy and safety of tranexamic acid prophylaxis for hemorrhage during and after selective cesarean section,and to provide evidence for clinical use of tranexamic acid.Methods:The use of PubMed database,Cochrane Library database,CNKI China biomedical journal full-text database and document database,Wanfang database,supplemented by manual retrieval literature review of related literature at home and abroad,All clinical randomized controlled trials were conducted on preoperative prophylactic use of tranexamic acid to reduce bleeding during and after selective cesarean section.The retrieval time was up to March 31,2019.Data extraction and quality evaluation were conducted on the studies that met the inclusion criteria,and Meta analysis was conducted using Revman 5.3 software.Result:A total of 15 references meeting the inclusion criteria were included,including2373 patients,1193 of whom were treated with tranexamic acid preoperatively,and1180 of whom were in the control group.Compared with the control,Meta analysis results showed that the patients in the use of tranexamic acid group can significantly reduce the amount of blood loss during cesarean section(SMD =-2.19,95%CI =-2.96~-1.42,P<0.00001),The amount of blood loss 2 hours after surgery(SMD =-1.49,95% CI =-2.09~-0.90,P<0.00001),The amount of blood loss 24 hours after surgery(SMD =-2.03,95% CI =-3.24~-0.82,P = 0.001)and blood transfusion needs(RR =0.25,95% CI =0.11 ~ 0.57,P=0.0009).Difference between the two groups has statistical significance.Nevertheless,There was no significant difference in incidence of thromboembolic events(RR =0.76,95% CI =0.19 ~3.03,P=0.70)and incidence of neonatal asphyxia(RR =1.64,95% CI =0.52~5.17,P=0.39)between the two groups.Conclusion:Compared with placebo or no treatment,intravenous tranexamic acid injection before operation can reduce the amount of blood loss and blood transfusion needs during and after selective cesarean section,and does not increase the risk of maternal thrombotic disease and neonatal asphyxia,which has certain effectiveness and safety for mother and child.It provides a new preventive measure for reducing perioperative bleeding and promoting postpartum recovery.