The Impact of Intravenous Tranexamic Acid on Hemoglobin and Hematocrit Levels after Cesarean Delivery in Women at Low Risk for Postpartum Hemorrhage: A Randomized Controlled Trial

Cesarean section (CS) results in about twice the blood loss as vaginal delivery. Blood loss can cause decreased hemoglobin and hematocrit. Few studies have been done on the effect of tranexamic acid on hemoglobin and hematocrit levels after delivery with controversial results. This study was therefore designed to determine the effect of intravenous tranexamic acid on hemoglobin and hematocrit after CS in women at low risk for postpartum hemorrhage.

This randomized controlled trial was performed on 50 pregnant women referred to Izadi hospital, Qom, Iran, from August 15, 2016 to April 30, 2017. Subjects were randomly assigned into two groups of 25 using block randomization. The intervention group received 1 gr tranexamic acid 10 minutes before CS, while the control group received 1 gr distilled water. Hemoglobin and hematocrit were measured before and 12-24 hours after delivery. Also, the volume of blood loss from placental delivery was measured 2 hours after delivery. T-test was used to compare the differences between the two groups.

There was no significant difference in pre-operative and 12-24 h postoperative hemoglobin (12.17±1.21 vs 11.72±0.99 mg/dl) and hematocrit (37.73±2.38 vs 36.22±2.41mg/dl) in the two groups (P>0.05). However, Tranexamic acid significantly reduced the volume of total blood loss from placental delivery in the first 2 hours after delivery (616.32±176.87 vs 731.45±178.79mg/dl, P=0.028).

Reduced blood loss after tranexamic acid was not associated with improvement of post-operative hemoglobin and hematocrit. Therefore, tranexamic acid should be prescribed according to the clinical condition and possible complications.