Efficacy of prophylactic tranexamic acid in preventing postpartum hemorrhage following repeat cesarean sections: a retrospective matched-cohort study
- 1Guangzhou Women and Children’s Medical Center, Guangzhou Medical University , ,
Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, and women with repeat cesarean sections are at high risk. This study aimed to evaluate the efficacy of prophylactic tranexamic acid (TXA) in preventing PPH among women undergoing repeat cesarean sections.
Methods: A retrospective cohort study was conducted including women with repeated cesarean sections at a tertiary obstetrical center in South China between July 2016 and December 2023. Patients were divided into the TXA group and the control group according to intraoperative prophylactic TXA administration. Given the imbalance in baseline characteristics, 1:2 propensity score matching (PSM) with a caliper of 0.01 was performed to balance confounding variables. The primary outcome was PPH incidence. Secondary outcomes included estimated blood loss, hemoglobin decline, additional uterotonic use, and blood transfusion rate.
Results: After 1:2 PSM, 2,777 women in the TXA group were matched with 5,554 women in the control group, with baseline characteristics well balanced. The incidence of PPH was significantly lower in the TXA group than in the control group (11.09% vs. 17.03%, P < 0.001). The TXA group also demonstrated less calculated estimated blood loss, smaller hemoglobin reduction (12.06% vs. 18.44%, P < 0.001), and lower requirements for additional uterotonic agents (26.90% vs. 29.80%, P = 0.006). Multivariate logistic regression confirmed that prophylactic TXA was an independent protective factor against PPH (OR 0.620, 95% CI 0.540-0.712, P < 0.001). No significant difference was observed in blood transfusion rates (1.55% vs. 2.09%, P = 0.089).
Conclusion: Prophylactic TXA use was associated with a lower incidence of PPH and the need for additional uterotonics in women undergoing repeat cesarean sections. Randomized trials in this specific population are needed.
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BibTeX
@article{di2026efficacy,
title = {{Efficacy of prophylactic tranexamic acid in preventing postpartum hemorrhage following repeat cesarean sections: a retrospective matched-cohort study}},
author = {Xiaodan Di and Xiaojun Li and Zheng Zheng and Lanlan Guo and Taowei Dong and Qiaozhu Chen},
journal = {Frontiers in drug safety and regulation},
year = {2026},
month = oct,
doi = {10.3389/fdsfr.2026.1911287},
url = {https://europepmc.org/article/PMC/PMC13720946},
note = {CC BY},
}
RIS
TY - JOUR
TI - Efficacy of prophylactic tranexamic acid in preventing postpartum hemorrhage following repeat cesarean sections: a retrospective matched-cohort study
AU - Xiaodan Di
AU - Xiaojun Li
AU - Zheng Zheng
AU - Lanlan Guo
AU - Taowei Dong
AU - Qiaozhu Chen
PY - 2026
DA - 2026/10/16
JO - Frontiers in drug safety and regulation
DO - 10.3389/fdsfr.2026.1911287
UR - https://europepmc.org/article/PMC/PMC13720946
AB - Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, and women with repeat cesarean sections are at high risk. This study aimed to evaluate the efficacy of prophylactic tranexamic acid (TXA) in preventing PPH among women undergoing repeat cesarean sections. Methods: A retrospective cohort study was conducted including women with repeated cesarean sections at a tertiary obstetrical center in South China between July 2016 and December 2023. Patients were divided into the TXA group and the control group according to intraoperative prophylactic TXA administration. Given the imbalance in baseline characteristics, 1:2 propensity score matching (PSM) with a caliper of 0.01 was performed to balance confounding variables. The primary outcome was PPH incidence. Secondary outcomes included estimated blood loss, hemoglobin decline, additional uterotonic use, and blood transfusion rate. Results: After 1:2 PSM, 2,777 women in the TXA group were matched with 5,554 women in the control group, with baseline characteristics well balanced. The incidence of PPH was significantly lower in the TXA group than in the control group (11.09% vs. 17.03%, P < 0.001). The TXA group also demonstrated less calculated estimated blood loss, smaller hemoglobin reduction (12.06% vs. 18.44%, P < 0.001), and lower requirements for additional uterotonic agents (26.90% vs. 29.80%, P = 0.006). Multivariate logistic regression confirmed that prophylactic TXA was an independent protective factor against PPH (OR 0.620, 95% CI 0.540-0.712, P < 0.001). No significant difference was observed in blood transfusion rates (1.55% vs. 2.09%, P = 0.089). Conclusion: Prophylactic TXA use was associated with a lower incidence of PPH and the need for additional uterotonics in women undergoing repeat cesarean sections. Randomized trials in this specific population are needed.
SN - 2674-0869
ER -