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Tranexamic acid versus misoprostol for management of postpartum hemorrhage: A systematic review and meta-analysis of randomized controlled trials.
Abu-Zaid, Ahmed; Baradwan, Saeed; Albouq, Bayan; Ghazi, Ahmed; Khadawardi, Khalid; Bukhari, Ibtihal Abdulaziz; Alyousef, Abdullah; Abdulmalik, Nadia Ahmed; Alblewi, Hedaya; Alsehaimi, Saud Owaimer; Albadawi, Mohamed Ismail; Abuzaid, Mohammed; Alomar, Osama; Salem, Hany.
Afiliación
  • Abu-Zaid A; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Electronic address: aabuzaid@live.com.
  • Baradwan S; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
  • Albouq B; Department of Obstetrics and Gynecology, Prince Mohammed Bin Abdulaziz National Guard Hospital, Madinah, Saudi Arabia.
  • Ghazi A; Department of Obstetrics and Gynecology, College of Medicine, Jeddah University, Jeddah, Saudi Arabia.
  • Khadawardi K; Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
  • Bukhari IA; Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
  • Alyousef A; Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
  • Abdulmalik NA; Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
  • Alblewi H; Department of Obstetrics and Gynecology, National Guard Hospital, Riyadh, Saudi Arabia.
  • Alsehaimi SO; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Albadawi MI; College of Medicine, Almaarefa University, Riyadh, Saudi Arabia.
  • Abuzaid M; Department of Obstetrics and Gynecology, Muhayil General Hospital, Muhayil, Saudi Arabia.
  • Alomar O; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Salem H; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Eur J Obstet Gynecol Reprod Biol ; 291: 61-69, 2023 Dec.
Article en En | MEDLINE | ID: mdl-37832480
AIM: To conduct the first-ever systematic review and meta-analysis of randomized controlled trials (RCTs) on the antihemorrhagic utility and safety of tranexamic acid (TXA) versus misoprostol for management (prevention and/or treatment) of postpartum hemorrhage (PPH). METHODS: Six databases were screened from inception until May 2023 and updated in September 2023. The RCTs were assessed for quality according to the Cochrane's risk of bias tool. The endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. RESULTS: Ten RCTs with 2121 patients (TXA = 1061 and misoprostol = 1060) were analyzed. There was no significant difference between TXA and misoprostol groups regarding the mean intraoperative blood loss (n = 9 RCTs, MD = 17.32 ml, 95% CI [-40.43, 75.07], p = 0.56), mean change in hemoglobin (n = 6 RCTs, MD = 0.11 mg/dl, 95% CI [-0.1, 0.31], p = 0.30), mean hospital stay (n = 2 RCTs, MD = -0.3 day, 95% CI [-0.61, 0.01], p = 0.06), blood transfusion rate (n = 4 RCTs, RR = 0.49, 95% CI [0.16, 1.47], p = 0.2), and rate of additional uterotonic agents (n = 4 RCTs, RR = 1.05, 95% CI [0.72, 1.53], p = 0.81). Leave-one-out sensitivity analysis showed robustness of the results, and there was no evidence of publication bias. Regarding safety endpoints, there was no significant difference between both groups regarding the rates of minor side effects, such as diarrhea, fever, nausea, and vomiting. No patient developed thromboembolic events in the TXA group. CONCLUSION: There was no significant antihemorrhagic efficacy between adjunct TXA and misoprostol for the management of PPH. The safety profile was comparable between both agents.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Hemostáticos / Misoprostol / Hemorragia Posparto / Antifibrinolíticos Tipo de estudio: Systematic_reviews Límite: Female / Humans / Pregnancy Idioma: En Revista: Eur J Obstet Gynecol Reprod Biol Año: 2023 Tipo del documento: Article Pais de publicación: Irlanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Hemostáticos / Misoprostol / Hemorragia Posparto / Antifibrinolíticos Tipo de estudio: Systematic_reviews Límite: Female / Humans / Pregnancy Idioma: En Revista: Eur J Obstet Gynecol Reprod Biol Año: 2023 Tipo del documento: Article Pais de publicación: Irlanda