Table 1 : Characteristics of the randomized controlled trials that have assessed tranexamic acid for the prevention of postpartum hemorrhage after cesarean deliveries.

Study [ref]CountryStudy designSample sizeStudy groupsProphylactic uterotonicsInterventionTXA dosage/route/durationPrimary outcome/ calculated sample size/flow chartMethod for assessing estimated blood lossResultP-valueAdverse effects
Gai et al., (2004) [16] China Prospective, single-centre, randomized, controlled N=180, primiparas, elective CS under epidural analgesia N=91 (experimental)
N=89 (no placebo)
10 IU oxytocin IV simultaneously with 20 IU oxytocin into the intrauterine wall Infusion of TXA 10 min before CS 1 g IV for 5 min Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of materials used+materials not used−weight of all materials before surgery)/1.05, +volume included in the suction container from placental delivery to 2 h postpartum 359.3 vs 439.3 ml 0.002 No thromboembolic or other side effects reported

Gohel
et al., (2007) [17]
India Prospective, single-centre, randomized, controlled N=100, primiparas and multiparas, elective CS under spinal anaesthesia N=50 (experimental)
N=50 (no placebo)
10 IU oxytocin IV for 30 min with 0.4 mg methylergometrine IV Infusion of TXA 20 min before CS 1 g IV for 5 min Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of materials used−weight of material before use)+volume included in the suction container from placental delivery to 2 h postpartum 374.9 vs 472.8 ml 0.003 No thromboembolic or other side effects reported

Sekhavat
et al., (2009) [18]
Iran Prospective, single-centre, randomized, controlled N=90, primiparas, elective CS under general analgesia N=45 (experimental)
N=45 (placebo)
10 IU oxytocin IV for 30 min Infusion of TXA 10 min before CS 1 g IV for 5 min Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of materials used−weight of material before use)/1.05 from the end of CS to 2 h postpartum 28.0 vs 37.1 ml 0.001 No thromboembolic or other side effects reported

Gungorduk et al., (2011) [19] Turkey Prospective, single-centre, double-blinded, randomized, controlled N=666, primiparas and multiparas, elective CS* N=330 (experimental)
N=330 (placebo)
5 IU IV bolus oxytocin, then 30 IU oxytocin in 500 ml solution at a rate of 125 ml h−1 Infusion of TXA 10 min before CS 1 g IV for 5 min Estimated blood loss during CS.
Yes, 327 per group
Yes
Estimated blood loss=EBV×(preop haematocrit−postop haematocrit)/preop haematocrit 600.7 vs 499.9 ml <0.001 Gastrointestinal side effects (16.3%) in the experimental group
Gastrointestinal side effects not mentioned for the placebo group
No thromboembolic events

Movafegh et al., (2011) [20] Iran Prospective, single-centre, double-blinded, randomized controlled study N=100, primiparas and multiparas, elective CS under spinal anaesthesia N=50 (experimental)
N=50 (placebo)
10 IU oxytocin IV
over 20 min,
then 30 IU
oxytocin over 8 h
Infusion of TXA 20 min before CS 10 mg/kg IV for 10 min Postpartum blood loss not clearly mentioned
Yes, 50 per group
Not reported
Method of Gai et al [22] 262.5 vs 404.7 ml <0.001 No thromboembolic events

Xu et al., (2013) [21] China Randomized, single-centre, double-blinded, controlled study N=174, primiparas, elective CS under spinal anaesthesia N=88 (experimental)
N=86 (placebo)
10 IU oxytocin IV for 30 min with 0.4 mg methylergometrine IV Infusion of TXA 10 min before CS 10 mg/kg IV for 5 min Postpartum blood loss not clearly mentioned
Yes, 76 per group
Not reported
Method of Gai et al [22] 379 vs 441 ml 0.02 2 thromboses occurred in each group
Gastrointestinal side effects occurred in 10 TA patients vs 1 placebo patient

Sentürk
et al., (2013) [22]
Turkey Randomized, single-centre, double-blinded, controlled study N=223, primiparas and multiparas, elective and emergency CS under spinal anaesthesia N=101 (experimental)
N=122 (placebo)
20 IU IV bolus oxytocin Infusion of TXA 10 min before CS 10 mg/kg IV for 5 min Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of wet–dry pads
or tampon)/1.05
272 vs 347 ml 0.001 No thromboembolic or gastrointestinal side effects

Shahid
et al., (2013) [23]
Pakistan Randomized, single-centre, double-blinded, placebo-controlled study N=74, primiparas and multiparas, elective CS under spinal anaesthesia N=38 (experimental)
N=36 (placebo)
5 IU oxytocin and
0.4 mg methylergometrine
IV bolus then 30 IU oxytocin over 6 h
Infusion of T XA 10 min before CS
Measurement of blood loss from the time of placental delivery to end of CS
1 g IV Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of materials used - weight of material before use)+volume included in the suction container from the placental delivery to the end of CS 356 vs 710 ml <0.001 No thromboembolic side effects

Abdel-Aleem
et al., (2013) [24]
Egypt Randomized, single-centre, open, controlled study N=740, primiparas and multiparas, elective CS under spinal anaesthesia N=373 (experimental)
N=367 (no placebo)
5 IU IV bolus and
20 IU IV infusion of oxytocin
Infusion of TXA 10 min before CS 1 g IV for 10 min Blood loss 2 hr after delivery
Yes, 350 per arm
Yes
(weight of all towels used - weight of dry towels)× 0.9+volume included in the suction container from the placental delivery to 2 h postpartum 241.6 vs 510.6 ml <0.001 Gastrointestinal side effects (74.3% vs 53.1%; P=0.0001)
No thromboembolic side effects

Goswami
et al., (2013) [25]
India Randomized, single-centre, double-blinded, placebo controlled study N=90, primiparas and multiparas, elective CS under spinal anaesthesia N=30 (experimental 1)
N=30 (experimental 2)
N=30 (placebo)
20 IU oxytocin in
500 ml at the rate
of 8 mU min−1 IV
Infusion of TXA 20 min before CS Experimental 1: 10 mg/kg
Experimental 2: 15 mg/kg
Postpartum blood loss not clearly mentioned
Not reported
Not reported
(weight of all towel used - weight of dry towels)×0.9+volume included in the suction container from the placental delivery to 2 h postpartum 376.8 vs 261.2 vs 527.2 ml Not reported No thromboembolic side effects

Table created by Sentilhes et. al, Tranexamic acid for postpartum haemorrhage, published in British Journal of Anaesthesia, January 2015, pages 4,5, by permission of Oxford University Press.
CS: Cesarean Section; TXA: Tranexamic acid; IV: Intravenous; EBV: Estimated blood volume=the woman’s weight (kg)x8

Viswanath et al.Journal of Anesthesiology and Clinical Science  2015 4:4DOI : 10.7243/2049-9752-4-4