Effect of Prophylactic Tranexamic Acid on Perioperative Blood Loss in High-Risk Cesarean Delivery: A Randomized Controlled Study
Year: 2026
Type: preprint
Abstract: Background Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality. Although tranexamic acid (TXA) is recommended for the treatment of established PPH, the clinical benefit of its prophylactic administration during cesarean delivery, particularly in women at increased risk of hemorrhage, remains uncertain. Methods Women aged 18–45 years with American Society of Anesthesiologists physical status II and at increased risk of PPH who were scheduled for elective cesarean delivery under spinal or general anesthesia were enrolled. The anesthesia technique was selected before randomization. Participants were subsequently stratified by anesthesia type and randomized within each stratum to receive either 1 g intravenous TXA after umbilical cord clamping or no TXA. All patients received a standardized uterotonic regimen. The primary outcome was estimated blood loss calculated using perioperative hematocrit values. Secondary outcomes included the incidence of blood loss > 500 and > 1000 mL, blood transfusion, perioperative changes in hemoglobin and hematocrit, additional uterotonic requirements, adverse events, and thromboembolic events during the three-month follow-up period. Eighty-four women were enrolled, and 83 were included in the final analysis. Results Estimated blood loss was 511 mL in the spinal anesthesia–TXA group, 590 mL in the spinal anesthesia control group, 579 mL in the general anesthesia–TXA group, and 617 mL in the general anesthesia control group. No statistically significant differences were observed among the groups in estimated blood loss, the incidence of blood loss > 500 or > 1000 mL, transfusion requirements, perioperative hemoglobin or hematocrit changes, or additional uterotonic use (all P > 0.05). Adverse-event rates were also comparable among groups. No thromboembolic events were identified during the three-month follow-up period. Conclusions In women at increased risk of PPH undergoing elective cesarean delivery, 1 g intravenous TXA administered after umbilical cord clamping was not associated with a statistically significant reduction in estimated blood loss or other hemorrhage-related outcomes under either spinal or general anesthesia. Given the limited sample size, the absence of statistically significant differences should be interpreted cautiously and does not exclude a potential prophylactic benefit of TXA. Trial Registration ClinicalTrials.gov, NCT07870499. Registered on October 6, 2026. Retrospectively registered.
Source: Research Square
Authors: Burçin ÖNDER, Mert YETGİN, Aslı METE YILDIZ
Institution: Pamukkale University
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225640904