BACKGROUND AND PURPOSE:

• Sentilhes et al. (AJOG, 2022) compared the effect of TXA vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies

METHODS:

• Secondary analysis of multicenter, randomized, placebo-controlled, double-blind trial with 2 parallel groups
  • TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized (TRAAP2) trial
• Population
  • Multiple pregnancy
  • Cesarean delivery before or during labor at ≥34 weeks of gestation
• Intervention
  • TXA: 1 g IV, plus prophylactic uterotonics
  • Placebo, plus prophylactic uterotonics
• Primary outcome
  • Calculated estimated blood loss of >1000 mL or a red blood cell transfusion by 2 days post-delivery
• Secondary outcomes
  • Clinical and laboratory blood loss measurements

RESULTS:

• TXA: 147 individuals | Placebo: 152 individuals
  • All multiples were twins
• There was no difference in the incidence of the primary outcome between the intervention groups
  • TXA: 42.2%
  • Placebo: 44.1%
  • aRR 0.97 (95% CI, 0.68 to 1.38); P=0.86
• There were also no significant between-group differences for any hemorrhage-related clinical outcome (P>0.05 for all comparisons)
  • Gravimetrically estimated blood loss | Provider-assessed clinically significant hemorrhage | Additional uterotonics | Postpartum blood transfusion | Arterial embolization | Emergency surgery

CONCLUSION:

• The use of prophylactic TXA did not reduce the risk for blood loss or hemorrhage-related outcomes in individuals with multiple pregnancy at time of cesarean
• The authors state

Further randomized controlled trial (RCT) studies are required to determine whether prophylactic TXA plus a prophylactic uterotonic agent would be associated with a lower incidence of postpartum hemorrhage after cesarean delivery than the uterotonic agent alone in high-risk populations, such as women with placenta previa or those with preeclampsia 

Learn More – Primary Sources:

Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial

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