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

Abstract

(Am J Obstet Gynecol 2022;227:889e1–17) Tranexamic acid (TXA) has been proposed as a preventive medication in obstetrics to reduce the risk of postpartum hemorrhage (PPH). However, previous research has not shown TXA to be clinically beneficial for vaginal or cesarean delivery among a general obstetric population. Information is lacking on whether TXA might be more effective for women who are at increased risk of PPH. This study aimed to evaluate the effectiveness of prophylactic TXA in one group of women at high risk for PPH—those with multiple gestation. The purpose of this study was to examine the effect of TXA and a uterotonic agent compared with the uterotonic agent alone on the risk of PPH. The primary outcome was the incidence of calculated estimated blood loss of more than 1000 mL or a red blood cell transfusion by day 2 after delivery. Secondary outcomes included clinical and laboratory measurements of postpartum blood loss, adverse effects related to TXA, and maternal satisfaction.