Eficacia del ácido tranexámico ante medicamentos útero tónicos para el control de la hemorragia posparto primaria. Revisión sistemática

Abstract

Postpartum hemorrhage is defined by the World Health Organization (WHO) as blood loss of 500 ml or more within the first 24 hours after vaginal delivery and 1,000 ml or more after cesarean delivery, causing hemodynamic alterations in the patient. Common causes include uterine tone abnormalities, trauma, retained tissue, or coagulopathies. Objective: To determine the efficacy of tranexamic acid compared to the use of uterotonic drugs for the control of primary postpartum hemorrhage. Methodology: A systematic literature review was conducted, with searches performed in databases such as PubMed, SpringerLink, Elsevier, and Frontiers. Keywords were combined using Boolean operators like AND to optimize results. The review included studies in English and Spanish published after 2020, all available in open access. Literature references were managed with Zotero, articles were analyzed using the NIH tool, and the risk of bias was evaluated with ROB-2. Results: Thirteen articles meeting the specific objectives were included. Seven analyzed tranexamic acid, and six focused on oxytocin and carbetocin, the leading uterotonic drugs. All the drugs achieved the primary outcomes specified in the articles. However, oxytocin was more likely to cause maternal adverse effects. Conclusions: All analyzed drugs demonstrated high efficacy in achieving the primary objective of reducing bleeding levels. Treatment lasted up to 10 minutes, with varying dosages based on population characteristics. Oxytocin presented the highest incidence of adverse effects, notably tremors. Keywords: tranexamic acid, hemorrhage, postpartum hemorrhage, oxytocin