Anti-fibrinolytic agents in post partum haemorrhage: a systematic review

All randomised controlled trials of anti-fibrinolytic agents given for bleeding during the postpartum period were included in this review. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled trials, Web of Science, metaRegister of controlled trials, LILACS, Reproductive Health Library, African healthline, POPLINE, MedCarib, CINAHL, Clinicaltrials.gov and the reference lists of eligible trials. Two authors extracted data. Methodological quality was assessed by evaluating allocation concealment. The primary outcome was maternal mortality. Secondary outcomes were blood loss, blood transfusion, hysterectomy, mean haemoglobin concentration, thrombo-embolic events and other adverse effects.We identified three randomised controlled trials involving 461 participants. The trials compared tranexamic acid with no treatment and reported blood loss after delivery. In all three trials, allocation concealment was either inadequate or unclear. The administration of tranexamic acid was associated with a reduction in blood loss of 92 millilitres (95%CI 76 to 109). The most frequently reported adverse effect of tranexamic acid was nausea, although the increase was easily compatible with the play of chance (RR 4.63, 95%CI 0.23 to 95.14).Tranexamic acid may reduce blood loss in post partum haemorrhage. However, the quality of the currently available evidence is poor. Adequately powered, high quality randomised controlled trials are needed.Each year, worldwide, about 536,000 women die from causes related to pregnancy and childbirth. Almost all (99%) of the deaths are in low and middle income countries.[1] Postpartum haemorrhage is the most common cause of maternal death.[2] Of the 14 million women who have postpartum haemorrhage each year, 1–2% die, with an average interval from onset of bleeding to death of 2 to 4 hours.[2] Haemorrhage is also an important cause of maternal mortality in high income countries, accounting for about 13% of maternal deaths.[3]Postpa