Tranexamic acid for the prevention of postpartum bleeding: Protocol for a systematic review and individual patient data meta-analysis

Katharine Ker, Haleema Shakur-Still, Loïc Sentilhes, Luis D. Pacheco, George Saade, Catherine Deneux-Tharaux, Amy Brenner, Raoul Mansukhani, François Xavier Ageron, Danielle Prowse, Rizwana Chaudhri, Oladapo Olayemi, Ian Roberts

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Background: Tranexamic acid (TXA) reduces the risk of death and is recommended as a treatment for women with severe postpartum bleeding. There is hope that giving TXA shortly before or immediately after birth could prevent postpartum bleeding. Extending the use of TXA to prevent harmful postpartum bleeding could improve outcomes for millions of women; however we must carefully consider the balance of benefits and potential harms. This article describes the protocol for a systematic review and individual patient data (IPD) meta-analysis to assess the effectiveness and safety of TXA for preventing postpartum bleeding in all women giving birth, and to explore how the effects vary by underlying risk and other patient characteristics.   Methods: We will search for prospectively registered, randomised controlled trials involving 500 patients or more assessing the effects of TXA in women giving birth. Two authors will extract data and assess risk of bias. IPD data will be sought from eligible trials. Primary outcomes will be life-threatening bleeding and thromboembolic events. We will use a one-stage model to analyse the data. Subgroup analyses will be conducted to explore whether the effectiveness and safety of TXA varies by underlying risk, type birth, maternal haemoglobin (Hb), and timing of TXA. This protocol is registered on PROSPERO (CRD42022345775).  Conclusions: This systematic review and IPD meta-analysis will address important clinical questions about the effectiveness and safety of the use of TXA for the prevention of postpartum bleeding that cannot be answered reliably using aggregate data and will inform the decision of who to treat.  

Original languageEnglish (US)
Article number3
Pages (from-to)3
JournalGates Open Research
Volume7
DOIs
StatePublished - May 12 2023

Keywords

  • Anti-fibrinolytics
  • Tranexamic acid
  • childbirth
  • meta-analysis
  • postpartum haemorrhage

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)
  • Immunology and Microbiology (miscellaneous)
  • Health Policy
  • Public Health, Environmental and Occupational Health

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