Introduction: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Multiple clinical trials evaluated tranexmic acid (TXA) for treatment and prevention of PPH, but there is currently insufficient evidence to support prophylactic use. Our objective was to conduct a systematic review and meta-analysis using available data from randomized clinical trials (RCT) that evaluated the efficacy of TXA prophylaxis during cesarean section.

Methods: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 with relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCTs were abstracted and meta-analysis performed using the Mantel-Haenszel fixed effects model with test of heterogeneity.

Results: 27 RCTs were identified for prophylactic use of TXA at cesarean section; which included 4728 women. Only a single study included women at high risk for PPH. Administration of TXA was significantly associated with reduction of mean estimated blood loss (EBL) (27 studies, n=4728, OR 0.45, 95% CI 0.41–0.50), PPH1000 mL (6 studies, n= 1986, OR 0.27, 95% CI 0.18-0.43), use of blood transfusions (12 studies, n=2813, OR 0.33, 95% CI 0.20-0.54), and need for other medical interventions (9 studies, n=2577, OR 0.39, 95% CI 0.29-0.53). Only 4 cases of VTE in 4366 women were reported which occurred similarly in controls and TXA.

Conclusion/Implications: In an overall low risk patient population, prophylactic TXA at cesarean section was effective in reducing mean EBL, PPH1000, blood transfusions, and need for other medical interventions. Additional research is needed to elucidate optimal regimens to maximize efficacy and minimize risk.