Assessment the role of tranexamic acid in prevention of postpartum hemorrhage
Tóm tắt
Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH.
The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage.
The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22).
Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.
Từ khóa
Tài liệu tham khảo
Abdel-Aleem H, Alhusaini TK, Abdel-Aleem MA, Menoufy M, Gülmezoglu AM (2013) Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. J Matern Neonatal Med 26(17):1705–1709 [cited 2021 Jan 10]
Alam A, Bopardikar A, Au S, Barrett J, Callum J, Kiss A et al (2017) Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1). BMJ Open 7(10):1–8
Butterworth J, Mackey DC, Wasnick J (2013) Chapter 51. Fluid Management & Blood Component Therapy. In: Morgan & Mikhail’s clinical anesthesiology, 5e | AccessMedicine McGraw-Hill Medical [Internet]. [cited 2021 Jan 10]. McGraw-Hill, New York, p 1168
Committee on Practice Bulletins-Obstetrics (2017) Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol 130(4):e168–e186. https://doi.org/10.1097/AOG.0000000000002351
Ducloy-Bouthors A-S, Jeanpierre E, Saidi I, Baptiste A-S, Simon E, Lannoy D et al (2018) TRAnexamic acid in hemorrhagic CESarean section (TRACES) randomized placebo controlled dose-ranging pharmacobiological ancillary trial: study protocol for a randomized controlled trial. Trials 19(1):1–16.
Kandappan G, Anand B (2016) Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section in multigravida parturients: a case controlled prospective study. J Evid Based Med Healthc 3(48):2419–2425. https://doi.org/10.18410/jebmh/2016/532
Lier H, Maegele M, Shander A (2019) Tranexamic acid for acute hemorrhage: a narrative review of landmark studies and a critical reappraisal of its use over the last decade. Anesth Analg 129(6):1574–1584. https://doi.org/10.1213/ANE.0000000000004389
Neb H, Zacharowski K, Meybohm P (2017) Strategies to reduce blood product utilization in obstetric practice. Curr Opin Anaesthesiol 30(3):294–299. https://doi.org/10.1097/ACO.0000000000000463
Pabinger I, Fries D, Schöchl H, Streif W, Toller W (2017) Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis. Wien Klin Wochenschr 129(9–10):303–316. https://doi.org/10.1007/s00508-017-1194-y
Pacheco LD, Hankins GDV, Saad AF, Costantine MM, Chiossi G, Saade GR (2017) Tranexamic acid for the management of obstetric hemorrhage. Obstet Gynecol 130(4):765–769. https://doi.org/10.1097/AOG.0000000000002253
Pacheco LD, Saade GR, Hankins GDV (2019) Medical management of postpartum hemorrhage: an update. Semin Perinatol 43(1):22–26. https://doi.org/10.1053/j.semperi.2018.11.005
Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C (2013) The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 17(10):1–79. https://doi.org/10.3310/hta17100
Salem M, Mohamed M, Salem A, Abbas A (2016) Tranexamic acid as prophylactic therapy for intra and post partum hemorrhage, randomized controlled trial. Br J Med Med Res 17(2):1–7. https://doi.org/10.9734/BJMMR/2016/26288
Sentilhes L, Daniel V, Deneux-Tharaux C (2020) TRAAP2-TRAnexamic acid for preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, doubleblind, placebo-controlled trial- a study protocol. BMC Pregnancy Childbirth 20(1):1–11
Sentürk MB, Cakmak Y, Yildiz G, Yildiz P (2013) Tranexamic acid for cesarean section: a double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet 287(4):641–645. https://doi.org/10.1007/s00404-012-2624-8
Shakur H, Roberts I, Fawole B, Chaudhri R, El-Sheikh M, Akintan A et al (2017) Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 389(10084):2105–2116. https://doi.org/10.1016/S0140-6736(17)30638-4
Solomon C, Collis RE, Collins PW (2012) Haemostatic monitoring during postpartum haemorrhage and implications for management. Br J Anaesth 109(6):851–863. https://doi.org/10.1093/bja/aes361