Efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section

Background: In India, caesarean section rate is rising, so the impact of prophylactic injection of tranexamic acid in decreasing blood loss during caesarean section would be more beneficial in terms of having minimal blood loss intra operatively and post operatively and thereby decreasing maternal morbidity. The objective of the study was to evaluate the efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section. Methods: A randomized controlled trial among 200 term women with singleton pregnancy for a period of 2 years was carried out. They were randomized by computer generated numbers into two groups: study group-100 women receiving prophylactic tranexamic acid women and control group-100 women receiving placebo. Results: The blood loss during caesarean section was less in the tranexamic acid group compared to the placebo group. Similarly blood loss measured 6hrs after caesarean section was less in the tranexamic acid group compared to placebo group. 20-40min before the time of incision was the ideal time gap for administering the injection tranexamic acid for its optimum efficacy. Tranexamic acid group had lesser requirement of uterotonic when compared to placebo, but need for blood transfusion was similar in both the groups. Greater fall in the hemoglobin and haematocrit occurred in placebo group compared to tranexamic acid group. No changes in the post-operative vitals or side effects were seen in the tranexamic acid group. Even no change in birth weight and Apgar scores was seen in neonates of tranexamic acid group. Conclusions: Injection tranexamic acid is the, antifibrinolytic agent that can be used for prophylactic administration before caesarean section for decreasing blood loss during surgery.