Efficacy and safety of tranexamic acid in prevention of postpartum hemorrhage: a systematic review and meta-analysis of 18,649 patients

Al-dardery, Nada Mostafa; Abdelwahab, Omar Ahmed; Abouzid, Mohamed; Albakri, Khaled; Elkhadragy, Ali; Katamesh, Basant E.; Hamamreh, Rawan; Mohd, Ahmed B.; Abdelaziz, Ahmed; Khaity, Abdulrhman

doi:10.1186/s12884-023-06100-8

Table 3 Shows the assessment of the certainty in evidence using the GRADE framework

From: Efficacy and safety of tranexamic acid in prevention of postpartum hemorrhage: a systematic review and meta-analysis of 18,649 patients

*Outcome*	*Mode of birth throughout*	*Effect Size, 95% CI, and P value*	*Number of studies*	*Study Design*	*Risk of Bias*	*Inconsistency*	*Indirectness*	*Imprecision*	*Others*	*Evaluation*
Total blood loss	CB	MD 2.11, 95% CI [-3.09 to -1.14], P < 0.001 [7, 24,25,26, 29, 31, 32, 34, 37,38,39,40,41, 45, 47,48,49, 54,55,56,57, 60,61,62,63,64,65, 68,69,70,71, 75]	32	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Total blood loss	VB	MD -0.89, 95%CI [-1.47 to -0.31], P = 0.01 [6, 18, 27, 30, 42, 50, 66, 73, 74, 76, 77]	11	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Occurrence of PPH	CB	OR 0.34, 95%CI [0.24 to 0.47], P < 0.001 [12, 24, 26, 28, 29, 34, 35, 37, 39, 41, 43, 47, 48, 52,53,54,55, 60, 64, 65, 69,70,71, 75]	24	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Occurrence of PPH	VB	OR 0.52, 95%CI [0.34 to 0.81], P = 0.02 [18, 27, 36, 46, 50, 58, 66, 74, 76, 77]	10	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High
Mean change in Hb	CB	MD 1.11, 95%CI [1.03 to 1.38], P < 0.001 [7, 24,25,26, 29, 31, 32, 34, 37,38,39,40,41, 45, 47,48,49, 54,55,56,57, 60,61,62,63,64,65, 68,69,70,71, 75]	32	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Mean change in Hb	VB	MD 0.20, 95%CI [-0.07 to 0.48], P = 0.15 [18, 36, 42, 46, 50, 76, 77]	7	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Intraoperative blood loss	CB	MD -1.96, 95%CI [-2.77 to -1.15], P < 0.001 [12, 24, 26, 28, 33,34,35, 38, 39, 44, 45, 49, 51,52,53, 56, 57, 62,63,64, 67, 70,71,72, 75]	25	RCT	The downgrade	Downgrade by one level	No downgrade	No downgrade	None	Moderate
Intraoperative blood loss	VB	MD 0.05 mL, 95%CI [-0.21 to 0.31], P = 0.70 [30, 50]	2	RCT	No downgrade	No downgrade	No downgrade	The downgrade by one level	None	Moderate
Postoperative blood loss	CB	MD -1.54, 95%CI [-2.02 to -1.06], P = 0.01 [12, 24, 26, 28, 33, 34, 38, 39, 44, 45, 49, 51,52,53, 56, 57, 59, 62,63,64, 67, 70,71,72, 75]	25	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Postoperative blood loss	VB	MD -0.55 mL, 95%CI [-0.73 to -0.37], P = 0.01 [36, 50, 78]	3	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High
Additional uterotonic agent	CB	OR 0.46, 95%CI [0.34 to 0.62], P = 0.01 [24, 25, 29, 33, 37, 38, 41, 48, 53, 54, 60,61,62, 65]	14	RCT	No downgrade	The downgrade by one level	No downgrade	No downgrade	None	Moderate
Additional uterotonic agent	VB	OR 0.55, 95%CI [0.37 to 0.80], P = 0.02 [18, 27, 30, 36, 42, 46, 50, 58, 66, 76, 77]	11	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High
Occurrence of nausea or/and vomiting	CB	OR 1.36, 95%CI [1.07 to 1.74], P = 0.01 [12, 31, 32, 35, 38, 43, 52,53,54, 57, 60, 69,70,71]	14	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High
Occurrence of nausea or/and vomiting	VB	OR 2.36, 95%CI [1.32 to 4.21], P = 0.02 [27, 30, 36, 50, 66, 74, 77, 78]	8	RCT	No downgrade	Downgrade by one	No downgrade	No downgrade	None	High
Incidence of hysterectomy	CB	OR 1.59, 95%CI [0.71 to 3.53], P = 0.26 [25, 37, 53, 54, 60, 64, 69]	7	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High
Incidence of hysterectomy	VB	OR 0.34, 95%CI [0.07 to 1.75], P = 0.20 [27, 30, 78]	3	RCT	No downgrade	No downgrade	No downgrade	No downgrade	None	High

Others are publication bias, large effect, dose–response, and plausible confounding factors
High indicates that we are extremely certain that the actual effect is close to the effect estimate
Moderate indicates that the impact estimate has moderate confidence: the actual effect is likely to be close
Low indicates that the confidence about the result is limited and the true effect can be different from our result
RCTs Randomized Control Trials, CI Confidence Interval

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ISSN: 1471-2393

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