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Efficacité et sécurité de l'acide tranexamique en prévention et/ou en traitement de l'hémorragie du post-partum: Une revue systématique de la littérature avec méta-analyse

par Faraoni, David ;Carlier, C.;Samama, Charles C.M.;Levy, Jerrold J.H.;Ducloy-Bouthors, Anne Sophie
Référence Annales françaises d'anesthésie et de réanimation, 33, 11, page (563-571)
Publication Publié, 2014-11

Article révisé par les pairs

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Résumé :

Objective(s): Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage. Study design: Systematic review with meta-analysis. Material and methods: Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage. Results: Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9 mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74) None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30. minutes after randomisation (P= 0.03) and confirmed after 6 hours (median: 170 mL (58-323) vs 221 mL (110-543), P= 0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration. Conclusion: Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.